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Research & Scholarship

Current Research and Scholarly Interests

Dr. Koopman's current research includes the following:

1) A collaboration with experts in Lyme disease and biostatistics to examine diverse manifestations of Lyme disease and their relationships to demographic and medical characteristics and diagnostic tests.

2) In collaboration with the Sierra Streams Institute in Nevada City, we are pilot-testing the feasibility, acceptability and satisfaction associated with an intervention using at-home group video conferencing designed to improve quality of life among women in rural communities who have been diagnosed with breast cancer.

4) Collaborating (as Co-Investigator) with Dr. Oxana Palesh (PI) and colleagues on research to evaluate a brief behavioral intervention for insomnia duringchemotherapy.

Clinical Trials

Phase I: At-Home Support for Rural Women Using Group Video CallingNot Recruiting

This randomized phase I trial studies at-home group video calling sessions in quality of life
in rural patients with breast cancer. At-home group video calling support sessions may
improve the well-being and quality of life of women who have breast cancer

Stanford is currently not accepting patients for this trial.For more information, please contact Cheryl Koopman, 650-723-9081.

This research study will examine the usefulness of groups in reducing stress and helping
individuals with HIV to stay healthy and avoid problems associated with sexually transmitted
diseases. We hope to discover whether being in a group is effective in reducing
stress-related symptoms and promoting healthy behaviors.

PRIMARY OBJECTIVE(S):
The purpose of this study is to test the efficacy of brief behavioral therapy versus control
condition that accounts for time and attention (nutrition education) in the treatment of
insomnia in humans.
SECONDARY OBJECTIVE(S):
To assess the impact of different biomarkers on sleep disruption and other patient reported
outcomes

The study will answer two questions about women with breast cancer in rural communities:
1. Will they find this support group format utilizing videoconferencing acceptable and
rewarding?
2. Will they report a greater sense of emotional and informational support, and less
depression and traumatic stress, than the control groups of women who wait to
participate until after the first groups have ended?

Stanford is currently not accepting patients for this trial.For more information, please contact Adelaida Castillo, (650) 725 - 5590.

Recent research provides evidence that disrupted circadian rhythms, including hormonal
patterns and sleep, are associated with increased risk of breast cancer incidence and faster
progression to mortality. We have observed that a loss of normal diurnal cortisol rhythm
associated with more awakenings during the night predicts early mortality with metastatic
breast cancer. Other recent studies have shown that nighttime shift work is associated with
higher breast cancer incidence, and in a murine model disrupting circadian cortisol cycles
produced a doubling of implanted tumor growth. There is also recent evidence that abnormal
clock genes are associated with cancer. However, it is not clear whether sleep disruption per
se affects breast cancer progression, or whether such an effect is mediated by hormonal and
immune dysregulation of this prevalent and hormone-mediated cancer. We propose to study sleep
disruption as a prognostic factor in the progression of metastatic breast cancer. We will
also examine sleep patterns in association with disrupted circadian rhythms of cortisol,
ACTH, and melatonin as well as measures of immune function known to be salient to breast
cancer progression. These are natural killer cell cytoxicity and specific cytokine, IL-6. We
plan to recruit 105 women 45 years through 75 years with metastatic or recurrent breast
cancer and 20 age and SES-matched controls for a two-week at home sleep study with Actiwatch
and two nights of in-home EEG monitoring, followed by 28 hours of continuous blood sampling
and one night of EEG sleep monitoring in our lab at Stanford. This will provide a full
examination of circadian hormones associated with sleep patterns. We will relate these
assessments to the subsequent course of breast cancer progression. Results of this study will
provide specific evidence regarding how improved sleep management may affect the course of
breast cancer. Aim 1: To study 24-hr diurnal rhythms of HPA axis hormones and melatonin in
women with metastatic or recurrent breast cancer. Hypothesis 1: Women with metastatic or
recurrent breast cancer will have reduced amplitude and disrupted phase of 24-hr diurnal
rhythms of cortisol, ACTH, and melatonin. Aim 2: To describe sleep disruption in women with
metastatic breast cancer and examine psychosocial, endocrine, and immune factors that may be
associated with sleep disruption. Hypothesis 2: Women with metastatic or recurrent breast
cancer will have a higher incidence of both at home and laboratory-examined sleep disruption
than control women without breast cancer. Hypothesis 3: Poorer sleep quality will be
associated with more pain, more emotional suppression in response to stressors, less
emotional support, greater depression and anxiety, and greater perceived and traumatic
stress. Hypothesis 4: Poorer sleep quality and quantity of sleep and daytime sleepiness and
fatigue will be associated with abnormal circadian neuroendocrine (i.e., cortisol, ACTH, and
melatonin) and immune patterns (i.e., suppressed day and night time NK activity and loss of
NK rhythms; increased day time IL-6 levels and /or loss of IL-6 rhythm). Aim 3: To study the
relationship between sleep disruption and survival time among metastatic and recurrent breast
cancer patients. Hypothesis 5: Poorer sleep quality and quantity of sleep will predict
shorter survival. Hypothesis 6: Reduced diurnal amplitude and an abnormal phase of cortisol
will predict shorter survival. Explanatory Aim 4: To investigate whether sleep disruption
mediates the relation of psychosocial factors to health outcomes.

Stanford is currently not accepting patients for this trial.For more information, please contact Bita Nouriani, (650) 723 - 8479.

The major goal of this project is to test the feasibility and acceptability of using
videoconferencing to provide support groups led by trained facilitators to rural women with
breast cancer in northern California.

Abstract

Anxiety is prevalent, distressing, and understudied among patients with advanced lung cancer and their family caregivers. Preliminary evidence suggests that anxiety is not only present in both patients and caregivers but shared by the dyad. Few studies have examined the nature of shared anxiety and its impact on patient-caregiver dyads.This study was developed to identify shared causes and manifestations of anxiety experienced by patients with stage IV non-small cell lung cancer (NSCLC) and their primary caregivers. Data were collected through in-depth semi-structured interviews with ten matched patient-caregiver dyads and one unmatched patient (N?=?21) recruited from two comprehensive cancer care centers.Using grounded theory, eight themes emerged characterizing shared causes and manifestations of anxiety: (1) uncertainty, (2) loss and impending loss, (3) changing roles, (4) conflict outside the dyad, (5) finances, (6) physical symptoms, (7) fears of decline and dying, and (8) life after the patient's passing. All themes were shared by patients and caregivers.Implications for future research include the development and evaluation of interventions to reduce anxiety in cancer patient-caregiver dyads.

Abstract

An estimated 11% of the adult population in Malawi, Africa, is living with HIV/AIDS. The disease has taken a toll on communities, resulting in high morbidity and mortality. Malawian women carry the burden of being caretakers for individuals infected with HIV while also worrying about their own health. However, little is known about how HIV/ AIDS affects psychological functioning among Malawian women in areas hit hardest by the epidemic. To that end, this paper examined the influence of HIV-related stigma on symptoms of anxiety and depression among 59 women 17-46 years old who were recruited from the Namitete area of Malawi. Women who reported greater worry about being infected with HIV and greater HIV-related stigma were significantly more likely to report greater symptoms of anxiety and depression. These findings suggest that interventions that reduce HIV-related stigma are likely to enhance psychological functioning among Malawian women, which in turn will improve the women's quality of life and well-being.

Abstract

The aim of this study is to review the recent literature on established cognitive tests and appropriate screening methods for amnestic mild cognitive impairment (MCI) in East/Southeast Asian older adults with a focus on those with low education.Peer-reviewed empirical studies conducted in Asia (China, Hong Kong, Japan, Korea, Singapore, and Taiwan) were identified using databases in psychology and medicine with combinations of the search terms "mild cognitive impairment," "dementia," "screening," "literacy," "illiteracy," "low education," "informant," "family," "cognitive test," "memory complaints," "activities of daily living," and "clinical dementia rating," limiting articles to those published in English since 1 January 2002. Of note, is that the term "amnestic mild cognitive impairment" was not used for searching the articles because the related cognitive impairment were often categorized non-specifically as MCI, but participants included those with amnestic cognitive challenges. Hence, the general term "MCI" has been used often throughout the text.Twelve studies that examined MCI screens were identified. An integrative approach using a combination of cognitive test and informant-based measure may be more sensitive or accurate than using any single screening method alone.MCI misdiagnosis may be prevalent, highlighting the need for early collaborative work between informants and clinicians to improve the accuracy of this diagnosis in older Asian adults with low education. Findings were suggestive, although restricted in generalizability even within similar cultural groups or neighboring regions. Clinical application is limited, but some findings provide guidance for future research.

Abstract

This study is an exploratory, qualitative investigation of breast cancer survivors' experiences of paradox, following psycho-spiritual integrative therapy (PSIT). Previous studies examined the role of paradox in spiritual development among women diagnosed with cancer; this study investigated a psycho-spiritual intervention for multicultural cancer survivors. Twelve multicultural breast cancer survivors, from a sample of 30 women participants in an 8-week PSIT group intervention, were recruited from oncologists, hospitals, support groups, outpatient oncology centers, surgeons, radiation therapy centers, cancer events, and websites. We conducted semi-structured, open-ended interviews lasting 1-2 h regarding participants' experiences coping with cancer and their experience of PSIT. We transcribed interviews and conducted blind searches for both new and previously identified paradoxes and themes. Two previously identified themes emerged: (1) attempting to maintain coherence in new and old ways and (2) letting go of ultimate control in life. Additionally, three novel themes emerged: (1) interconnection between helpers and hinderers, (2) spiritual edges and tensions, and (3) new paths to empowerment. Results of this qualitative analysis indicate participants experienced previously identified themes and experienced an expanded range of paradoxes. After learning compassionate acceptance through PSIT, breast cancer survivors develop greater access to the multidimensionality of paradoxes, which can go beyond a binary (either/or) construction to a more interdependent (both/and) relationship. Devoting greater attention to investigating and understanding how diverse participants engage with and move through paradoxical change processes could enhance the effectiveness of existential and spiritual interventions.

Abstract

This study sought to understand the context in which Psycho-Spiritual Integrative Therapy (PSIT), a group intervention, promotes varying degrees of spiritual growth and quality of life change in breast cancer survivors. A secondary aim was to explore the relationship between spiritual well-being (SWB) and Quality of Life (QL) in PSIT participants. A qualitative, multiple case analysis was undertaken to examine the experiences of two participants with the highest change scores on the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale-Expanded Version (FACIT-Sp-Ex) and two participants with among the lowest change scores on this measure. The participant factors thought to contribute to SWB and QL changes included utilization of metacognitive psychological skills and spiritual/religious frameworks, while PSIT factors included application of PSIT core intervention components, cognitive restructuring, group dynamics, and the role of the facilitator. The nature and extent of participant use of spiritual practices appeared to shape the relationship between SWB and OL. The findings suggest directions for future research to investigate potential moderators and mediators of treatment efficacy of PSIT specifically, as well as other psycho-spiritual interventions for cancer survivors more generally.

Abstract

Child sexual abuse has been associated with a number of problems affecting women over their lifespan, including difficulties with parenting. However, there is a modest number of qualitative studies examining the impact of child sexual abuse on survivors who are mothers. There is a particular need for qualitative investigations that ask survivors who are mothers general questions about the impact of child sexual abuse on their lives rather than those that specifically ask about the impact of child sexual abuse on parenting. The former approach would allow survivors to describe effects that may impact parenting but that survivors do not consciously link to affecting their parenting. Such information may inform interventions to assist this population of survivors. This secondary data analysis examined themes revealed in interviews with 44 survivors of child sexual abuse who were mothers. Participants were seeking treatment for their child sexual abuse and completed an in-person interview in which they were asked open-ended questions about the sexual abuse they experienced as a child and how their abuse affects them now as adults. The interviews were recorded, transcribed, and coded using thematic analysis. The following six themes emerged from the narratives: (a) being a parent, (b) family of origin dysfunction, (c) the impact of abuse, (d) the abuse history and response to abuse, (e) coping, and (f) hopes and desires for the future. This study highlights several ways in which child sexual abuse impacts survivors who are mothers, areas for further study, and the need for interventions to assist this population in meeting the challenges they face as mothers.

Abstract

Maternal mortality in Uganda has remained relatively high since 2006. We studied access to mobile phones and people's interest in receiving audio-based maternal health lessons delivered via a toll-free telephone line. Interviews were conducted, using a male and a female translator, with 42 men and 41 women in four villages located in eastern rural Uganda. Most of the participants were recruited through systematic sampling, but some were recruited through community organizations and antenatal clinics. Ownership of a mobile phone was reported by 79% of men and by 42% of women. Among those who did not own a mobile phone, 67% of men and 88% of women reported regularly borrowing a mobile phone. Among women, 98% reported interest in receiving maternal mobile health lessons, and 100% of men. Providing local communities with mobile maternal health education offers a new potential method of reducing maternal mortality.

Abstract

This pilot study explored students' responses to feedback about their own and their peers' depression symptoms. The study also examined how experiences with the normative feedback might vary according to academic exposure to depression-related topics.For 9 weeks, female undergraduates (N?=?73) completed a weekly web-based version of the 8-item Patient Health Questionnaire, which gauges depression symptom levels. Next, they participated in semi-structured face-to-face interviews where they responded to the personalized normative feedback. The interviews were transcribed, coded, and analyzed.Students responded favorably to the feedback and without notable distress. The feedback increased students' awareness of their own depression symptoms and those of their peers. Those with higher academic exposure to depression-related topics were more likely to have accurate perceptions of their peers' depression symptoms and were less likely to be surprised by information in the feedback than students with less exposure.Personalized normative feedback for depression symptoms has potential as an effective tool for promoting more accurate views of personal and peer depression symptoms and reducing barriers to help-seeking. Students with less academic exposure to depression-related topics may benefit from increased knowledge of how to gauge their own depression symptoms and increased awareness of their peers' symptoms. Further research is needed to more fully evaluate the effects of this feedback and to directly assess the effects of this feedback on help-seeking behaviors.

Abstract

This study tested a novel extension of P. P. Schnurr and B. L. Green's (2004) model of the relationships between trauma symptoms and health outcomes with specific application to HIV-positive men. A diverse sample of 167 HIV-positive men recruited from San Francisco Bay Area HIV clinics completed demographic, medical, trauma history, and symptom questionnaires. Mediation analyses were conducted using the method proposed by R. Baron and D. Kenny (1986). Regression analyses found that sexual revictimization (SR) significantly mediated the relationship between child sexual abuse and peritraumatic dissociation (PD), and PD mediated the relationship between SR and current posttraumatic stress (PTS) symptom severity. PTS symptoms partially mediated the relationship between SR and current HIV symptom severity. The findings indicate that among HIV-positive men, sexually revictimized men constitute a vulnerable group that is prone to PD, which places them at risk for posttraumatic stress disorder (PTSD) and worsened HIV-related health. Furthermore, traumatic stress symptoms were associated with worse HIV-related symptoms, suggesting that PTS symptoms mediate the link between trauma and health outcomes. This study highlights the need for future research to identify the biobehavioral mediators of the PTSD-health relationship in HIV-positive individuals.

Abstract

This study examined general self-efficacy in relation to sexual risk behavior among persons living with HIV and evaluated psychometric properties of the Positive Self Questionnaire, a novel measure of general self-efficacy. The Positive Self Questionnaire showed high internal consistency, a factor analysis supported by a single factor structure, and convergent validity supported by significant correlations in predicted directions with indicators of mental health. The Positive Self Questionnaire was related to unprotected sexual encounters, even after controlling for other factors. Results suggest that general self-efficacy is important to examine when assessing sexual risk behavior; an internally consistent measure is available for such endeavors.

Abstract

While some studies have examined the deleterious effects of childhood bullying on adults, no studies to date have focused on the effects of bullying on Persons Living with HIV (PLH), a particularly at-risk population. PLH experience higher rates of childhood and adulthood physical and sexual abuse than the population at large, and experience of childhood abuse appears to be predictive of sexual and other risk behaviors in this population. Thus it remains critical to examine rates of childhood bullying and correlates of bullying in adult PLH.A sample of 171 HIV-positive men over 18 years of age were recruited from the San Francisco Bay Area. All participants reported experiencing symptoms of traumatic stress. The participants were recruited as part of a larger study assessing a group intervention for individuals with HIV and symptoms of trauma. Self-report questionnaires were administered to assess participants' exposure to bullying in childhood and trauma symptoms in adulthood.Bullying was commonly reported by men in the current sample, with 91% of the sample endorsing having experienced some level of bullying before age 18. Having been bullied in childhood was significantly (p

Abstract

Research indicates that a significant proportion of people living with HIV/AIDS report symptoms of posttraumatic stress disorder (PTSD). Moreover, attachment style has been associated with psychological and behavioral outcomes among persons living with HIV/AIDS. Attachment style may influence the ability to cope with traumatic stress and affect PTSD symptoms. To examine the association between attachment style and coping with PTSD symptoms, we assessed 94 HIV-positive adults on self-report measures of posttraumatic stress, coping, and attachment style. In multiple regression analysis, avoidant attachment and emotion-focused coping were positively and significantly associated with greater PTSD symptomatology. Support was also found for the moderating effects of avoidant and insecure attachment styles on emotion-focused coping in relation to greater PTSD symptoms. Taken altogether, these results suggest that interventions that develop adaptive coping skills and focus on the underlying construct of attachment may be particularly effective in reducing trauma-related symptoms in adults living with HIV/AIDS.

Abstract

The purpose of this study was to describe a domain of spiritual coping known as "surrender," as experienced among women diagnosed with breast cancer who participated in Psycho-Spiritual Integrative Therapy (PSIT). Surrender is a concept similar to active acceptance, which has been studied extensively, but surrender in the context of spiritual supportive care has received little attention.After participating in PSIT, which includes exercises in surrender, 23 participants completed an open-ended questionnaire about their experiences of surrender. Twelve women whose responses were most complete and expressive were selected to be analyzed for this study. A thematic analysis was conducted to better understand how surrender experiences may contribute to supportive care.Four distinct themes were identified: experience of surrender, facilitation of surrender, inhibition of surrender, and ease and completeness of surrender. Although the manifestations of surrender varied, women were consistent in describing these experiences positively.These findings build upon previous evidence that spirituality, optimism, and active acceptance have a positive impact on well-being in cancer patients. The findings provide insight into the usefulness of PSIT for women with breast cancer and inform future research on the intervention.

Abstract

The purpose of this study was to examine the influence of denial coping on quality of life (QOL) over time among individuals living with HIV, as denial has been understudied as a coping strategy within the literature on HIV/AIDS.In a sample of 65 adult men and women, we used multilevel linear modeling to test trajectories of change in physical and mental health-related QOL across baseline, 3, 6, and 12 months, including denial as a predictor and gender as a moderator.The use of denial coping was associated with lower physical and mental health-related QOL at baseline. Denial coping predicted an increase in QOL over time, though QOL remained low in those who practiced denial coping. Men's baseline mental health-related QOL was more negatively affected by denial coping than women's. Women tended to increase in QOL more slowly over time compared to men.Reliance on denial as a coping strategy is associated with poorer physical and mental health-related QOL in an HIV-positive population, though participants who engaged in denial also displayed more rapid improvement in their QOL over time. Men and women displayed different rates of improvement in QOL, indicating a need for gender-based treatment approaches. Future research should examine the complex role of denial on change in QOL.

Abstract

Traumatic experiences are common among populations living with HIV; furthermore, the minority stress model indicates that sexual minority group members, such as men who have sex with men (MSM), are more likely to experience negative psychological outcomes after exposure to trauma, given the stress of minority stigma. The current study examined the prevalence of traumatic events and the impact of these events on trauma symptoms in a sample of 113 MSM and 51 men who have sex with women (MSW) who are living with HIV/AIDS. Rates of experiencing trauma were similar for both MSM and MSW. However, MSM, as sexual minority group members, were more likely to report symptoms of trauma and dissociation than MSW. The current study indicates that MSM may experience additional negative psychological outcomes after exposure to trauma. Findings are discussed in the context of implications for HIV prevention with sexual minority group members.

Abstract

This study examined stressors and barriers to using mental health services among first-generation immigrants in San Jose, California. Focus groups for 30 immigrants from Cambodia, Eastern Europe, Iran, Iraq, Africa, and Vietnam were audio-recorded, translated and transcribed. Two researchers coded the data and identified themes pertaining to mental health stressors and barriers. Six primary stressors were identified: economic, discrimination, acculturation due to language differences, enculturation, parenting differences, and finding suitable employment. Primary barriers included: stigma, lack of a perceived norm in country of origin for using mental health services, competing cultural practices, lack of information, language barriers, and cost. A conceptual model is presented that may be used to inform the design and implementation of mental health services for this population.

Abstract

This study examined the relationships among dissociation, childhood trauma and sexual abuse, and posttraumatic stress disorder (PTSD) symptoms in HIV-positive men. Data were collected from 167 men enrolled in a randomized clinical trial that examined a group therapy intervention to decrease HIV-related risk behavior and trauma-related stress symptoms. Participants completed the Trauma History Questionnaire, the Impact of Events Scale-Revised, and the Stanford Acute Stress Reaction Questionnaire. Overall, 35.3% of the participants reported having experienced childhood sexual abuse. A total of 55.7% of the sample met diagnostic criteria for PTSD. The intensity of dissociative symptoms that participants endorsed was positively associated with experience of childhood sexual abuse (r?=?.20, p < .01). Dissociative symptoms were also positively associated with specific PTSD symptoms, notably hyperarousal (r?=?.69, p < .001). Hierarchical regression indicated that hyperarousal symptoms accounted for more of the variance in dissociation than childhood sexual abuse. These results suggest that childhood sexual abuse may be involved in the development of dissociative symptoms in the context of adulthood stress reactions. Furthermore, the pattern of the association between dissociation and PTSD is consistent with the possibility of a dissociative PTSD subtype among HIV-positive men.

Abstract

Parents of hospitalized premature infants are at risk for developing psychological symptoms. This randomized controlled pilot study examined the effectiveness of a brief cognitive-behavioral intervention in reducing traumatic and depressive symptoms in mothers 1 month after their infant's discharge from the hospital. Fifty-six mothers were randomly assigned to the intervention or control group. Results showed that mothers experienced high levels of symptoms initially and at follow-up. At follow-up, there was a trend for mothers in the intervention group to report lower levels of depression (p = .06; Cohen's f = .318), but levels of traumatic symptoms were similar for both groups. Brief psychological interventions may reduce depressive symptoms in this population. Estimates of the effect sizes can be used to inform future intervention studies.

Abstract

HIV-infected individuals face a tremendous burden of psychiatric comorbidity. This study evaluates a community health care system's effort to screen for psychiatric disorders among patients at an HIV clinic and evaluate adherence to psychiatric service utilization.Standardized screening measures were used to identify participants who met diagnostic symptom criteria for post-traumatic stress disorder (PTSD), acute stress disorder (ASD) and depression. All participants who screened positive were referred for psychiatric follow-up. Rates of utilization were measured and barriers to adherence were investigated.Of the 210 participants, 118 patients met screening criteria for PTSD, ASD, and/or depression, and 116 of these had medical records available for review. Of the 116 patients with psychiatric comorbidity, 46.6% saw a psychiatrist and/or were prescribed a psychiatric medication. Thirty-two percent of Latinos, 40.5% of African Americans, and 38.5% of heterosexuals utilized referred psychiatric services, and these rates were significantly less than their counterparts. One hundred patients were seen by a social worker.While a large burden of psychiatric comorbidity exists among this population of HIV-positive patients, only half adhered to recommended psychiatric services referrals. Further research is warranted to examine cost-effective interventions to maximize psychiatric screening, referral, and follow-up with mental health services in this vulnerable population.

Abstract

Once medical treatment for gynecological cancer is completed, what happens to patients' sexuality and body image? Due to the delicate nature of the cancer site, treating this cancer typically affects sexual functioning and body image adversely, making it critical to identify the concerns of these patients and do so in a manner less restrictive than paper-and-pencil assessment. To gain a deeper understanding of the phenomenological experiences in question, we interviewed nine gynecological cancer patients and seven cancer-free women. After implementing a relaxation protocol, we asked each woman to describe her feelings and thoughts on her sexuality and body image in one-on-one interviews. A variety of themes emerged on patients' attitudes and perspectives concerning sexuality and body image following diagnosis and treatment of the cancer. The themes that were considerably different from those of the cancer-free women included decreased sexual functioning and body image, abrupt shifts in self-identity due to loss of physical integrity, and distancing in intimate relationships. Several implications of these findings for clinical practice are discussed, as well as the need to train medical professionals to properly assess these patients' alterations in sexuality.

Abstract

This study was conducted to evaluate a computer program named Help with Adjustment to Alopecia by Image Recovery (HAAIR) that was developed to provide educational support and reduce distress in women with hair loss following chemotherapy.Forty-five women who had been diagnosed with cancer and anticipated alopecia following treatment were randomly assigned to either the Imagining group (IG) or Standardized Care group (SCG). Patients in the IG used a computer-imaging program that created the patient's image on a screen to simulate baldness and use of wigs whereas patients in the SCG were directed to a resource room at the Cancer Center established for women with chemotherapy-related alopecia. Assessment data using the Brief Symptom Inventory, Importance of Hair Questionnaire, and the Brief Cope were completed at baseline (T1), before chemotherapy and hair loss, following hair loss (T2), and 3 months follow-up (T3).All women were able to successfully use the touch screen computerized-imaging program and reported that using the computer was a positive, helpful experience, thus establishing acceptability and usability. Women in both the IG and the SCG group showed significantly lower hair loss distress scores at T2 after hair loss than at T1 with T3 distress scores increasing in the SCG and decreasing in the IG. Those with avoidance coping reported more distress.This evaluation demonstrates that the HAAIR program is a patient-endorsed educational and supportive complement to care for women facing chemotherapy-related alopecia.

Abstract

The aim of this study was to describe challenges and strategies for coping with these challenges among individuals living in an institutional setting.This study used a qualitative approach to analyze the interviews of fourteen participants (11 males and 3 females) ages 10-24 residing in an Indonesian residential institution (orphanage and Muslim boarding school).Insufficient access to educational resources and basic necessities were major concerns of the participants, as was the residential institution's unresponsiveness and the lack of connection experienced by residents. Individuals coped with these challenges by turning to others for social support and by trying to change the focus of their thoughts, such as to more pleasant thoughts or simply to mentally disengage.Some youths and young adults residing in institutions such as a residential institution demonstrate resilience at the individual level by utilizing coping strategies to address problems in obtaining adequate educational, material and psychological support. However, because inadequacies in these kinds of support ultimately impede psychosocial development, it is imperative to develop solutions for addressing these problems at the institutional and societal level rather than at the level of individual youths and young adults.

Abstract

With high rates of trauma among HIV-positive men who have sex with men (MSM) who use methamphetamine, this preliminary pilot study examined the associations between experiential avoidance, trauma symptoms, and management of a chronic illness. Among a small sample of HIV-positive, methamphetamine-using MSM in a California Bay Area County, greater reported experiential avoidance was significantly related to greater reported trauma and symptoms of traumatic stress. Furthermore, greater reported experiential avoidance was significantly related to reduced self-efficacy of illness management and more frequent methamphetamine use. Although further research is needed, these data suggest that addressing issues of experiential avoidance and trauma could affect behavioral choices and treatment outcomes in this high-risk population.

Abstract

The motivation for clinical trials inventory-depression (MCTI-D) was developed and evaluated for assessing motivations to participate in clinical trials on depression. Sixty-four participants completed the MCTI-D: 40 individuals expressing interest in participating in a randomized clinical trial (RCT); and 24 clinic patients receiving traditional care for depression. Content validity was supported by feedback derived from a panel of experts in depression research and respondents completing the measure. The motivation most frequently endorsed for participating in an RCT was the desire to help others and/or to further science. The potential stigma associated with seeing a psychiatrist was reported to have the least influence. Patients expressed a greater likelihood to participate in RCTs that involved psychotherapy than in experimental medication or placebo-controlled trials. Data from the MCTI-D may provide useful information for depression researchers to consider as possible influences on patients' decisions about whether or not they will participate.

Abstract

The purpose of this study was to investigate the impact of mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1982, 1990) training on a self-selected adult community sample in the areas of mindfulness, rumination, depressive symptomatology and overall well-being. Targeting rumination was considered particularly important because a tendency toward rumination in nondepressed populations has been found to be predictive of subsequent onset of depression. As hypothesized, completers of the MBSR class showed increases in mindfulness and overall wellbeing, and decreases in rumination and symptoms of depression. Limitations of the study are discussed, as are the implications of these findings.

Abstract

To examine whether a group intervention including hypnosis can reduce cancer pain and trait hypnotizability would moderate these effects.This randomized clinical trial examined the effects of group therapy with hypnosis (supportive-expressive group therapy) plus education compared to an education-only control condition on pain over 12 months among 124 women with metastatic breast cancer.Pain and suffering, frequency of pain, and degree of constant pain were assessed at baseline and 4-month intervals. Those in the treatment group also reported on their experiences using the hypnosis exercises.Intention-to-treat analyses indicated that the intervention resulted in significantly less increase in the intensity of pain and suffering over time, compared to the education-only group, but had no significant effects on the frequency of pain episodes or amount of constant pain, and there was no interaction of the intervention with hypnotizability. Within the intervention group, highly hypnotizable participants, compared to those less hypnotizable, reported greater benefits from hypnosis, employed self-hypnosis more often outside of group, and used it to manage other symptoms in addition to pain.These results augment the growing literature supporting the use of hypnosis as an adjunctive treatment for medical patients experiencing pain.

Abstract

The relationships of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms were examined in 93 Sri Lankan university students who had experienced a traumatic life event. Posttraumatic growth was associated with peritraumatic dissociation and posttraumatic stress symptoms, but was not associated with peritraumatic emotional distress. Results indicated a curvilinear relationship between peritraumatic dissociation and posttraumatic growth and between posttraumatic stress symptoms and posttraumatic growth. In a regression model predicting posttraumatic growth scores, each of the quadratic relationships of peritraumatic dissociation and posttraumatic stress symptoms to posttraumatic growth were statistically significant, and combined accounted for 22% of the variance. Results suggest that moderate levels of peritraumatic dissociation and symptoms are most associated with the greatest levels of growth.

Abstract

This study evaluated the effectiveness of group psychotherapy in reducing levels of shame and guilt in adult survivors of childhood sexual abuse at risk for HIV, and whether such reductions would mediate the effects of treatment on posttraumatic stress disorder (PTSD) symptoms. One hundred sixty-six women were randomized into 3 conditions: a trauma-focused group, a present-focused group, and a waitlist group. Women received 6 months of treatment and were assessed at pretreatment (T1), immediately posttreatment (T2), and 6 months posttreatment (T3). Both treatment conditions resulted in reduced shame and guilt. The treatment effect on PTSD symptoms was mediated by changes in shame, but it was not associated with changes in guilt. These findings suggest that, when treating childhood sexual abuse survivors' PTSD, it is important to address the negative self-appraisals, such as shame, that commonly accompany such symptoms.

Abstract

The terrorist attacks of September 11, 2001 inflicted distress beyond those directly exposed, thereby providing an opportunity to examine the contributions of a range of factors (cognitive, emotional, social support, coping) to psychological resilience for those indirectly exposed. In an Internet convenience sample of 1281, indices of resilience (higher well-being, lower distress) at baseline (2.5-12 weeks post-attack) were each associated with less emotional suppression, denial and self-blame, and fewer negative worldview changes. After controlling for initial outcomes, baseline negative worldview changes and aspects of social support and coping all remained significant predictors of 6-month outcomes, with worldview changes bearing the strongest relationship to each. These findings highlight the role of emotional, coping, social support, and particularly, cognitive variables in adjustment after terrorism.

Abstract

Our aim with this qualitative study was to understand the role of personal values, meaning, and impact of drug use among HIV-positive men who have sex with men (MSM) who struggle with methamphetamine use. Participants were 22 MSM recruited from an ethnically diverse county in the San Francisco Bay area of California. Grounded theory was used to analyze the data collected in individual interviews. Emergent constructs of context, meaning, and perceived impact were identified and are described in a theoretical narrative format. The importance of broadening our understanding of HIV and methamphetamine addiction and their interaction is highlighted. This study contributes to the understanding of the complexity of methamphetamine use within the specific population of MSM living with HIV/ AIDS, and suggests possible directions for addressing important maintaining factors like adaptive use and enhancing factors that could contribute to an individual's ability to make better choices based on meaning and personal values.

Abstract

Having an infant hospitalized in the neonatal intensive care unit (NICU) is a highly stressful event for parents. Researchers have proposed posttraumatic stress disorder (PTSD) as a model to explain the psychological reaction of parents to their NICU experience.The authors sought to examine the prevalence of PTSD in parents 4 months after the birth of their premature or sick infants and the relationship of PTSD and symptoms of acute stress disorder (ASD) immediately after their infant's birth.Eighteen parents completed a self-report measure of ASD at baseline in addition to self-report measures of PTSD and depression at a 4-month follow-up assessment.In the sample, 33% of fathers and 9% of mothers met criteria for PTSD. ASD symptoms were significantly correlated with both PTSD and depression. Fathers showed a more delayed onset in their PTSD symptoms, but, by 4 months, were at even greater risk than mothers.The relatively high levels of psychological distress experienced by parents coupled with the potential negative outcomes on the parent and infant suggest that it is important to try to prepare parents for the expected psychological reactions that may occur in the event of a NICU hospitalization and also to support parents during the transition to home care.

Abstract

This study examined the long-term impact of parental cancer during childhood. Nineteen female and 8 male adults who had a parent with terminal or nonterminal cancer during childhood participated in face-to-face interviews during which they discussed how their parent's cancer affected their lives. Their interview responses were transcribed and analyzed using a constant comparative method of analysis. Posttraumatic growth experiences were reported by 44% of participants, and 59% reported adverse consequences. Future research should examine ways to identify factors that can help affected children experience posttraumatic growth while minimizing the adverse consequences of having a parent with cancer.

Abstract

We evaluated a new measure, the Cancer and Deity Questionnaire (CDQ), which assesses perceived relations with God after a cancer diagnosis. Based on object relations theory, the 12-item CDQ assesses benevolent and abandoning God representations. Sixty-one older participants with recent cancer diagnoses completed the questionnaire at baseline, and 52 of these participants completed the same questionnaire at follow-up. Internal consistency was excellent for the Benevolence scale (alpha = .97) and good for the Abandonment scale (alpha = .80). Moderate correlations with the Spiritual Well-Being Scale support divergent validity. Correlations between CDQ scales and the Styles of Religious Coping scales support convergent validity. The CDQ is brief, easily scored, practical for psycho-oncology research, and adaptable for use with other illnesses.

Abstract

We prospectively examined the effects of spiritual striving, social support, and acceptance coping on changes in depressive symptoms among adults living with HIV/AIDS. Participants were 180 culturally diverse adults with HIV/AIDS. Participants completed measures of spiritual striving, social support, coping styles, and depressive symptoms at baseline, three-month follow-up, and six-month follow-up. A path model showed that spiritual striving had direct and indirect inverse effects on changes in depressive symptoms. The relationship between spiritual striving and depressive symptoms was partially mediated by acceptance coping, but not by social support. Results suggest that people living with HIV/AIDS who strive for spiritual growth in the context of their illness experience less negative affect.

Abstract

Cross-sectional analysis of individual interviews with a convenience sample of persons living with tetraplegia.To describe patterns of residence among persons living with tetraplegia following discharge from initial acute medical care after spinal cord injury, decision-making process for each residence move and quality of life determinants at different residence types.California and Minnesota, United States.A total of 22 adults with traumatic spinal cord injury tetraplegia were interviewed about their residence histories, the residence decision-making process for each move, and positive and negative features at each residence at which they had lived.Information, money, insurance, accessibility, intimate relationships and personal assistants had the strongest influence over residence location, with insufficient information and finances demonstrating particularly strong influences. Participants frequently viewed parents' homes as an 'only option,' 'place of refuge' or 'stunting' environment. They viewed own homes as 'only options' or ways to achieve quality of life improvements, and other institutions as 'only options' or 'stepping-stones' to independent living.Further research is needed to examine decision-making across multiple moves over the course of the lives of persons living with tetraplegia, particularly examining the roles of inadequate information and finances as inhibitors of freedom of choice.

Abstract

The current study seeks to examine changes in distress associated with receiving time-limited dynamic psychotherapy (TLDP) among men who have sex with men (MSM) who are also living with HIV and AIDS. Participants included 79 HIV-seropositive MSM who were seeking psychotherapy at a community mental health clinic between January 2000 and June 2005. Participants' had a mean age of 42 and were predominantly European American (77%), although Latinos (13%), African Americans (5%), and Asian Americans (4%) were also included. Each participant completed a pretest on a self-report measure of subjective distress, the Outcome Questionnaire 45.2 (OQ-45.2), received 20 sessions of TLDP over the course of 20 weeks, and then completed a posttest on the OQ-45.2 to examine changes associated with TLDP. Participants' self-reported distress showed statistically significant decreases after 20 sessions of TLDP. Furthermore, the overall effects were strong, suggesting that decreases in distress were clinically meaningful as well as statistically significant. These results are particularly significant in light of the AIDS Health Project's (AHP's) policy of assigning higher functioning clients to TLDP therapists at intake, indicating that the participants in this study began treatment with lower pretest scores than mental health clients in the general population. These results suggest that HIV-seropositive MSM who receive TLDP may experience significantly decreased distress. Future research using a randomized study design is needed to compare such benefits to those of more standard psychological interventions for this population. Strengths and limitations of the study are discussed in detail.

Abstract

The psychological and physical demands of coping with medication side effects and comorbid illnesses can be overwhelming and may influence behaviors, such as medication adherence, substance use, sexual risk behavior, and exercise that, in turn, affect health outcomes. Cross-sectional and prospective studies among diverse populations of persons living with HIV suggest that these behavioral mechanisms may be associated with HIV disease progression. The motivation to change behavior is often highest in the immediate aftermath of a stressor. However, over time the motivation to continue a particular behavior change is often challenged by habits, environmental influences, and psychosocial factors. Furthermore, a number of studies suggest that behavioral mechanisms may mediate the relationship between psychosocial variables (e.g., stress, depression, coping, and social support) and disease progression in HIV. Thus, developing clinical interventions that address these psychosocial factors and enhance protective health behaviors and reduce behaviors that convey risk to health are likely to lessen overall morbidity and mortality among patients living with HIV/AIDS.

Abstract

The aim is to evaluate the effectiveness of a manualized 12-week supportive-expressive group therapy program among primary breast cancer patients treated in community settings, to determine whether highly distressed patients were most likely to benefit and whether therapist's training or experience was related to outcome.Three hundred and fifty-three women within one year of diagnosis with primary breast cancer were randomly assigned to receive supportive-expressive group therapy or to an education control condition. Participants were recruited from two academic centers and nine oncology practices, which were members of NCI's Community Clinical Oncology Program (CCOP) and were followed over 2 years.A 2x2x19 analysis of variance was conducted with main effects of treatment condition, cohort, and baseline distress and their interactions. There was no main effect for treatment condition after removing one subject with an extreme score. Highly distressed women did not derive a greater benefit from treatment. Therapist training and psychotherapy experience were not associated with a treatment effect.This study provides no evidence of reduction in distress as the result of a brief supportive-expressive intervention for women with primary breast cancer. Future studies might productively focus on women with higher initial levels of distress.

Abstract

This study examined relationships between cognitive and emotional processing with changes in pain and depression among intimate partner violence survivors. Twenty-five women who wrote about their most traumatic experiences completed measures of pain and depressive symptoms before the first writing session and again 4 months following the last writing session. Reduced pain was significantly associated with less use of positive and negative emotion words. Relationships between cognitive and emotional aspects of writing with changes in depressive symptoms fell short of statistical significance. The results suggest that emotional processing in narrative writing predicts changes in pain in intimate partner violence survivors.

Abstract

There is mixed evidence regarding the possible association between a history of stressful or traumatic life events and more rapid breast cancer progression.Retrospective reports of past experiences of traumatic life events were assessed among 94 women with metastatic or recurrent breast cancer. A traumatic event assessment was conducted using the event-screening question from the posttraumatic stress disorder (PTSD) module of the Structured Clinical Interview for the DSM-IV-TR (SCID; 2002). Each reported event was judged by two independent raters to determine whether it met DSM-IV-TR PTSD A1 criteria for a traumatic event. Those events that did not meet such criteria were designated "stressful events."Nearly 42% of the women in the sample were judged to have experienced one or more traumatic events; 28.7% reported only stressful events. A Kruskal-Wallis test found significant differences in disease-free interval among the three groups [chi2 (2, N=94)=6.09, P

Abstract

This study was designed to replicate our earlier finding that intensive group therapy extended survival time of women with metastatic breast cancer. Subsequent findings concerning the question of whether such psychosocial support affects survival have been mixed.One hundred twenty-five women with confirmed metastatic (n = 122) or locally recurrent (n = 3) breast cancer were randomly assigned either to the supportive-expressive group therapy condition (n = 64), where they received educational materials plus weekly supportive-expressive group therapy, or to the control condition (n = 61), where they received only educational materials for a minimum of 1 year. The treatment, 90 minutes once a week, was designed to build new bonds of social support, encourage expression of emotion, deal with fears of dying and death, help restructure life priorities, improve communication with family members and healthcare professionals, and enhance control of pain and anxiety.Overall mortality after 14 years was 86%; median survival time was 32.8 months. No overall statistically significant effect of treatment on survival was found for treatment (median, 30.7 months) compared with control (median, 33.3 months) patients, but there was a statistically significant intervention site-by-condition interaction. Exploratory moderator analysis to explain that interaction revealed a significant overall interaction between estrogen-receptor (ER) status and treatment condition (P = .002) such that among the 25 ER-negative participants, those randomized to treatment survived longer (median, 29.8 months) than ER-negative controls (median, 9.3 months), whereas the ER-positive participants showed no treatment effect.The earlier finding that longer survival was associated with supportive-expressive group therapy was not replicated. Although it is possible that psychosocial effects on survival are relevant to a small subsample of women who are more refractory to current hormonal treatments, further research is required to investigate subgroup differences.

Abstract

Although there are extensive data on the relationship between personality and stress reactivity in adults, there is little comparable empirical research with adolescents. This study examines the simultaneous relationships between long term functioning (personality, defenses) and observed stress reactivity (affect) in adolescents.High school students (N = 169; mean age 16; 73 girls) were asked to participate in two conditions of the Stress Induced Speech Task (SIST): Free Association and Stressful Situation. Immature and mature defenses, distress and restraint personality dimensions, and negative and positive affect were examined.Greater reported use of immature defenses was significantly associated with negative affect, whereas greater reported use of mature defenses was significantly associated with greater positive affect. Although personality style was also a significant predictor of negative affect across two out of three conditions, defenses were better overall predictors of affect than were personality dimensions. Gender was also a significant predictor of negative affect, wherein girls reported more negative affect than boys.Defenses and personality style predict affective response during a moderately stressful task. Immature defenses and, to a lesser extent, the distress personality dimension predict mobilization of negative affect, whereas mature defenses predict the reporting of positive affect. These results relate to processes central to psychotherapy: defensive responding, personality style, and affective reactivity during the recounting of stressful events.

Abstract

Women with breast cancer in rural areas are likely to exhaust their usual sources of psychosocial support while still facing challenges posed by breast cancer, but are unlikely to have access to professionally led support groups. In this community-based project, we assessed the feasibility and acceptability of providing support groups to women with breast cancer in a large rural area using videoconferencing and a workbook journal, and we assessed the intervention's potential to reduce distress and increase emotional expression and self-efficacy for coping with cancer. Twenty-seven women in the Intermountain Region of northeastern California participated in eight-session support groups led by an oncology social worker by going to nearby videoconferencing sites. Feasibility and acceptability were demonstrated. Older as well as younger women were comfortable using videoconferencing and said the groups were valuable because they promoted information sharing and emotional bonds with other women with breast cancer. They emphasized the importance of a professional facilitator and identified advantages of using videoconferencing for support groups. Pretest and posttest comparisons showed significant decreases in depression and posttraumatic stress disorder symptoms. The results suggest that the intervention has the potential to provide a valuable service that is not readily available in rural communities.

Abstract

This study investigates whether depression in women who experienced intimate partner violence is associated with having also experienced childhood sexual and physical abuse, psychological abuse by an intimate partner, recent involvement with the abusive partner, and bodily pain. Fifty-seven women who had left a violent relationship with an intimate partner completed measures assessing their demographic characteristics, experiences of abuse in childhood and in their relationship with their intimate partner, and depressive symptoms. Multiple regression analysis showed that women's depression was significantly greater among those who had experienced childhood physical and sexual abuse, more severe psychological abuse, and greater bodily pain (p

Abstract

Sleep disturbances are common among women with breast cancer and can have serious consequences. The present study examined depression, pain, life stress, and participation in group therapy in relation to sleep disturbances in a sample of women with metastatic breast cancer.Ninety-three women with metastatic breast cancer participated in a large intervention trial examining the effect of the group therapy on their symptoms. They completed measures of depression, pain, life stress, and sleep disturbance at baseline, 4, 8 and 12 months.The results showed that higher initial levels of depression at baseline predicted problems associated with getting up in the morning, waking up during the night, and daytime sleepiness. Increases in depression over the course of 12 months were associated with fewer hours of sleep, more problems with waking up during the night and more daytime sleepiness. Higher levels of pain at baseline predicted more problems getting to sleep. Increases in pain predicted more difficulty getting to sleep and more problems waking up during the night. Greater life stress at baseline predicted more problems getting to sleep and more daytime sleepiness.Depression, pain, and life stress scores were each associated with different types of negative change in self-reported sleep disturbances. Depression, especially worsening depression, was associated with the greatest number of types of negative change. The relationships found between sleep disturbance and depression, pain, and life stress suggest specific ways to address the problem of sleep disturbance for women with metastatic breast cancer and show how different types of disturbed sleep may be clinical markers for depression, pain, or life stress in this population.

Abstract

Considerable evidence suggests that people with HIV disease are significantly more distressed than the general population, yet psychiatric disorders are commonly under-detected in HIV care settings. This study examines the prevalence of three stress-related psychiatric diagnoses--depression, posttraumatic stress disorder (PTSD), and acute stress disorder (ASD), among a vulnerable population of HIV-infected patients. Among approximately 350 patients attending two county-based HIV primary care clinics, 210 participants were screened for diagnostic symptom criteria for depression, PTSD, and ASD. Standardized screening measures used to assess for these disorders included the Beck Depression Inventory, the Posttraumatic Stress Checklist, and the Stanford Acute Stress Questionnaire. High percentages of HIV-infected patients met screening criteria for depression (38 per cent), PTSD (34 per cent), and ASD (43 per cent). Thirty eight percent screened positively for two or more disorders. Women were more likely to meet symptom criteria for ASD than men (55 per cent vs. 38 per cent, OR=1.94, CI95 per cent=1.1-3.5). ASD was detected more commonly among African-American and white participants (51 per cent and 50 per cent respectively), compared with other ethnic groups. Latinos were least likely to express symptoms of ASD (OR=0.52, CI95 per cent=0.29-0.96). Of the 118 patients with at least one of these disorders, 51 (43 per cent) reported receiving no concurrent mental health treatment. Patients with HIV/AIDS who receive public healthcare are likely to have high rates of acute and posttraumatic stress disorders and depression. These data suggest that current clinical practices could be improved with the use of appropriate tools and procedures to screen and diagnose mental health disorders in populations with HIV/AIDS.

Abstract

An interactive web-site-based intervention for reducing alcohol consumption was pilot tested. Participants were 145 employees of a work site in the Silicon Valley region of California, categorized as low or moderate risk for alcohol problems. All participants were given access to a web site that provided feedback on their levels of stress and use of coping strategies. Participants randomized to the full individualized feedback condition also received individualized feedback about their risk for alcohol-related problems. Some evidence was found for greater alcohol reduction among participants who received full individualized feedback, although due to difficulties in recruiting participants, the sample size was inadequate for evaluating treatment effects on drinking. The results provide preliminary support for using an interactive web site to provide individualized feedback for persons at risk for alcohol problems. However, the low participation rate (2.7%) suggests that such an intervention must address the challenges of recruiting employees through their work site.

Abstract

This study examined predictors of posttraumatic stress disorder (PTSD) symptoms in adults who, as children, had a parent diagnosed with cancer. Possible predictors of adulthood PTSD examined were peritraumatic dissociation, satisfaction with social support, coping through denial, behavioral disengagement and self-distraction, and whether or not the parent died. Thirty research participants (20 women and 10 men, ages 18-38) were recruited who were 8-17-years old at the time of a parent's cancer diagnosis. Each participant completed measures of their current PTSD symptoms in response to their parent's cancer, peritraumatic dissociative experiences, demographic characteristics, and satisfaction with social support and use of coping strategies at the time of their parent's cancer diagnosis. Seventeen percent met screening criteria for likely PTSD. As hypothesized, PTSD symptoms were strongly and positively correlated with peritraumatic dissociation. Furthermore, PTSD symptoms were greater among females and were related to greater use of denial and behavioral disengagement and to less satisfaction with social support. These results suggest that health care providers need to recognize symptoms of peritraumatic dissociation in the children of parents who are diagnosed with cancer so that steps can be taken to minimize the children's development of PTSD that may extend into their adult lives.

Abstract

Provide counsel and support to women after a spontaneous abortion. Research indicates that many women will talk with their physician about their emotional distress and that physicians provide good information after the spontaneous abortion. Evaluate women for acute stress disorder (ASD) after a spontaneous abortion. Research found that women reporting physical, emotional, or sexual abuse are more likely to experience ASD. Patients should be assessed for post-traumatic stress disorder in follow-up visits 1 month after the initial visit. Research has found that up to 25% of women meet criteria for PTSD 1 month post the spontaneous abortion and 7% met criteria at 4 months. Physicians should refer women who are experiencing traumatic stress to a behavioral health professional.

Abstract

This prospective study examined the effect of maladaptive coping strategies and psychological quality of life (QOL) on depression at two time points in a diverse sample of persons living with HIV/AIDS (N = 85). The use of maladaptive coping strategies to deal with the stress of living with HIV/AIDS, particularly engaging in various kinds of avoidant behaviors, was significantly associated with greater depression at baseline and increased depression at three months. QOL was the single most important predictor of depression. In an effort to develop effective clinical methods aimed at decreasing depression among adults living with HIV, future studies need to focus on improving quality of life and increasing adaptive coping strategies associated with the stress of living with HIV/AIDS.

Abstract

To evaluate the psychometric properties of a new measure, the Abuse-Related Beliefs Questionnaire (ARBQ), designed to assess abuse-related beliefs among adult survivors of childhood sexual abuse (CSA). Study 1 examined the structure of the scale, and Study 2 evaluated its reliability and validity.One hundred and seventy female CSA survivors recruited into a group psychotherapy intervention study were administered the ARBQ in Study 1. A subsample of 45 women completed the ARBQ again 12 months later. In Study 2, 70 women from a health maintenance organization who identified themselves as survivors of CSA completed the ARBQ along with the Trauma Symptom Checklist-40 (TSC-40) and the Symptom Checklist 90R (SCL-90-R).Three reliable ARBQ subscales emerged in Study 1: Guilt, Shame, and Resilience. Twelve-month test-retest reliability was high (r=.60-.64). The internal consistency of the subscales was further supported in Study 2, and validity was demonstrated by moderate to high correlations with the distress measures.The results indicate that the ARBQ has good psychometric characteristics, supporting the feasibility of its use in measuring abuse-related beliefs in research on survivors of CSA. A next step for validation of the ARBQ would be to evaluate its sensitivity in measuring changes in studies of interventions for treating CSA survivors.

Abstract

This study examined the roles of religion and spirituality in relation to coping with breast cancer in Chilean women. Specifically, the purpose of the study was to examine how these patients used religion and spirituality to cope with their illness; how their illness changed the roles of religion and spirituality in their lives; and their views regarding whether, and if so how, spiritual faith can help patients recuperate from breast cancer. Twenty-seven women with breast cancer who were patients at a clinic in Santiago, Chile were recruited to participate in one-on-one interviews. The transcribed interviews were analyzed using the "constant comparative method" to seek patterns and organize the content into specific themes. Women viewed religion and spirituality as primary resources for themselves and others to use in coping with breast cancer. Women's use of religion and spirituality was manifested in praying, in their perceived dependence on God to intercede and guide them through their illness, and in obtaining social support from other persons in their faith community. Half (13/26) of the women reported that their cancer prompted an increased emphasis on religion and spirituality in their lives by deepening their faith in God. Almost all (26/27) participants endorsed the belief that spiritual faith can help cancer patients to recuperate. These findings suggest that health care providers working should be aware of the culturally dependent roles that religion and spirituality play in women's coping with breast cancer.

Abstract

The authors examined the prevalence of acute stress disorder (ASD) in parents of infants hospitalized in the neonatal intensive care unit (NICU). Forty parents were assessed after the birth of their infants. Parents completed self-report measures of ASD, parental stress, family environment, and coping style: 28% of parents developed symptoms of ASD. ASD was associated with female gender, alteration in parental role, family cohesiveness, and emotional restraint. Family environment and parental coping style are significantly associated with the development of trauma symptoms. Results from this study suggest potential interventions to help minimize psychological distress in parents.

Abstract

This study evaluated the relationships of emotional self-efficacy, stressful life events, and social support with mood disturbance among women diagnosed with breast cancer who live in rural communities. Eighty-two women completed measures of demographic characteristics, medical status, and psychosocial variables. Using multiple regression analysis, we found that greater mood disturbance was related to having less emotional self-efficacy (p < 0.001) and to having experienced more stressful life events (p = 0.02), while satisfaction with social support was not significantly related to mood disturbance (adjusted R2 = 0.39). Women living with breast cancer in rural communities who have experienced multiple stressful life events may have an increased risk for mood disturbance, whereas having greater emotional self-efficacy may provide resilience against mood disturbance.

HIV/AIDS stigma and knowledge among predominantly middle-class high school students in New Delhi, India.The Journal of communicable diseasesPramanik, S., Chartier, M., Koopman, C.2006; 38 (1): 57-69

Abstract

This study examined stigmatizing attitudes toward HIV/AIDS among predominantly middle-class adolescents in New Delhi high schools. This study was specifically designed to: 1) assess stigmatizing attitudes toward HIV/AIDS and sexuality; HIV/AIDS knowledge, and awareness of HIV-related health resources; and 2) examine whether HIV-related stigma and knowledge are related to one another and to gender, parents' education, and exposure to HIV/AIDS education. In four high schools in New Delhi, 186 students completed a questionnaire assessing stigmatization of HIV/AIDS, stigmatization of sexuality, knowledge of HIV/AIDS, HIV/AIDS education and resources, and demographic characteristics. Adolescents varied in how much they stigmatized persons with HIV/AIDS. They generally lacked accurate knowledge about the disease and of related health resources. However, those with greater exposure to HIV/AIDS education demonstrated significantly greater HIV/AIDS knowledge. Female adolescents demonstrated significantly less knowledge about HIV/AIDS compared with male adolescents, while the males reported significantly greater exposure to HIV/AIDS education compared with the females. These results suggest a need for greater HIV/AIDS education and awareness of health resources, especially among female adolescents. Education must directly address stigmatizing attitudes about HIV/AIDS, gaps in HIV/AIDS knowledge and awareness of HIV-related health resources.

Abstract

This study examined evidence for a dissociative subtype of post-traumatic stress disorder (PTSD) among women seeking psychotherapy for childhood sexual abuse (CSA). One hundred and twenty-two women seeking treatment for CSA completed a battery of questionnaires assessing PTSD, dissociative symptoms, and child maltreatment. Using signal detection analysis, we identified high and low dissociation PTSD subgroups. A constellation of three PTSD symptoms-hypervigilance, sense of foreshortened future, and sleep difficulties-discriminated between these two subgroups (OR = 8.15). Further evidence was provided by the finding of a nonlinear relationship between severity of childhood maltreatment and dissociation in the women with PTSD. These results provide support for a dissociative subtype of PTSD that may stem from more severe childhood experiences of neglect and abuse.

Abstract

This study examined self-efficacy, coping, and social support in relation to difficulties interacting with physicians and nurses among women living with breast cancer. One hundred women living in rural, mountainous communities of northeastern California were recruited, with 89 providing complete data for this study. All women completed a battery of questionnaires that included the CARES--Medical Interaction Subscale and measures of self-efficacy, coping, satisfaction with social support, and demographic and medical characteristics. In a multiple regression analysis, difficulties interacting with medical professionals were found to be greater among women who were not married, who used more behavioral disengagement or less self-distraction to cope with breast cancer, and who reported less self-efficacy for affect regulation and for seeking and understanding medical information. Emotional venting and satisfaction with social support for dealing with cancer-related stress were not, however, significantly related to difficulties in interacting with the medical team. This model accounted for an adjusted value of 42% of the variance. Further research is needed to identify possible causal relationships related to these findings and to determine what interventions might be warranted to improve medical interactions for women with breast cancer living in rural areas.

Abstract

This study examined social support and maladaptive coping as predictors of HIV-related health symptoms. Sixty-five men and women living with HIV/AIDS completed baseline measures assessing coping strategies, social support, and HIV-related health symptoms. The sample was primarily low-income and diverse with respect to gender, ethnicity, and sexual orientation. Three, 6, and 12 months after completing baseline assessments, physical health symptoms associated with HIV disease were assessed. After controlling for demographic characteristics, CD4 T-cell count, and baseline HIV-related health symptoms, individuals reporting lower increase in HIV-related health symptoms used less venting (expressing emotional distress) as a strategy for coping with HIV. However, when satisfaction with social support was added to the model, the use of this coping strategy was no longer significant, and individuals reporting more satisfying social support were more likely to report lower increase in their HIV-related health symptoms, suggesting that social support is a robust predictor of health outcomes over time independent of coping style and baseline medical status. These findings provide further evidence that social support can buffer deleterious health outcomes among individuals with a chronic illness. Future research needs to examine mediating pathways that can explain this relationship.

Abstract

This investigation examined relationships between breast cancer patients' psychosocial characteristics (impact of the illness, traumatic stress symptoms, emotional self-efficacy, and social support) and problems they perceived in their medical interactions and their satisfaction with their physicians. Participants were 352 women enrolled in a multicenter trial of the effects of group therapy for women with recently diagnosed primary breast cancer. The findings reported here are from a cross-sectional analysis of baseline data gathered prior to randomization. Problems interacting with physicians and nurses were associated with greater levels of cancer-related traumatic stress (p < 0.01), less emotional self-efficacy for cancer (p < 0.05), less satisfaction with informational support from family, friends, and spouse, and a tendency to perceive those sources of support as more aversive (p < 0.05). Women who were less satisfied with emotional support from their family, friends and spouse were less likely to feel satisfied with their physicians (p < 0.05). These patient characteristics identify women with primary breast cancer who are likely to experience difficulty in their interactions with nurses and physicians and to be less satisfied with their physicians.

Abstract

This study examined the effects of expressive writing on depression, posttraumatic stress disorder (PTSD) and pain symptoms among women who have survived intimate partner violence (IPV). Forty-seven women completed baseline and four-month follow-up assessments and were randomly assigned to four writing sessions of either expressive writing focused on traumatic life events or writing about a neutral topic. Main effects were not significant for changes in depression, pain or PTSD symptoms. However, among depressed women, those assigned to expressive writing showed a significantly greater drop in depression. For depressed women with IPV histories, expressive writing may lead to reduced depression.

Abstract

This randomized pilot study evaluates whether seropositive patients who are randomly assigned to receive a supportive-expressive group therapy plus education intervention show greater improvements in increased immune function and decreased viral load compared to those randomly assigned to an education-only intervention.Fifty-nine individuals who had been HIV-seropositive for at least 6 months prior to inclusion in the study and had been receiving standard pharmacologic treatment were entered in a prospective randomized trial of the effects of weekly supportive-expressive group therapy on changes in immune status. Participants were matched for AIDS status and sex and randomized to receive weekly sessions of group psychotherapy plus educational materials on HIV/AIDS, or to receive the educational materials alone. Participants were assessed before treatment and then 12 weeks later.Individuals who were randomized to group therapy showed a statistically significant increase in CD4 count and decrease in HIV viral load. Among individuals randomized to the education only condition, no significant change occurred in CD4 count or viral load.These results provide preliminary data suggesting that HIV-seropositive individuals who receive supportive-expressive group psychotherapy may experience concomitant improvements in CD4 cell count and viral load. Further research with a larger sample should examine the possible underlying mechanisms of such benefits.

Abstract

This study examined relationships between social support, stressful life events and antigen-specific cell-mediated immunity. Participants were 72 women with documented metastatic breast carcinoma, who completed self-report measures of social support and life stress. Immune response was assessed using the delayed type hypersensitivity (DTH) skin test. Number of positive antigens was significantly related to the interaction of social network size and stressful life events (p<0.05). Number of positive antigens was greater for women who had experienced a high frequency of stressful life events but who reported a larger network of support. However, social network size was inversely related to DTH response among women who had experienced fewer stressful life events. Average induration size was not significantly related to the quality of social support, life stress per se, or their interactions. The relationship between social network size and immune response in women with metastatic breast cancer depends on prior stressful life experience.

Abstract

Investigate the relationships between pain, stress, social support, and sleep disturbance among a diverse sample of HIV-positive adults.Participants (N = 146) completed self-report measures on pain, stress, social support, and sleep disturbance. CD4 T-cell count was obtained from medical records.Greater pain and stress were associated with greater sleep disturbance. Greater assistance from friends was associated with greater sleep disturbance, whereas greater understanding from friends regarding participants' HIV-related stress was associated with less sleep disturbance.As expected, pain was significantly associated with sleep disturbance. Additionally, psychosocial variables were strongly associated with sleep. The type of support from friends differentiated whether the support was positively or negatively associated with sleep problems. Social support, depending on the type, may not always be helpful for adults living with HIV/AIDS. Future studies need to examine factors that may mediate the relationship between psychosocial constructs and healthy sleep.

Abstract

This study assessed Internet use and attitudes toward illicit use of the Internet in a sample of Russian college students. A sample comprised of 198 students was recruited from a university in Moscow. Each participant completed a survey assessing demographic characteristics, Internet use, and attitudes towards engaging in illicit behaviors over the Internet. About half of the students reported that they used the Internet at least several times a year, with 8% reporting daily use of the Internet. Among Internet users, most reported having Internet access either at home or at a friends' home, and 16 % reported having Internet access from work, school, or a computer center. Among Internet users, the main purpose was for school-related activities (60%), followed by e-mail (55%), entertainment (50%), chatting (24%), and searching for pornography (6%). Although most students thought it was inappropriate to read someone else's e-mail, use someone else's password or credit card information without their permission, or break into someone's computer, many students did endorse those illicit behaviors. Over a fifth of the students reported that they knew hackers. Forty three percent of students agreed that people make too much fuss about watching videos, movies or downloading music on the Internet without paying. Males were more likely than females to report using the Internet for entertainment purposes (p = 0.006) and were more likely to agree that it was okay to break into someone's computer (p = 0.04). The results of this study suggest that these Russian college students predominately use the Internet to help with their schoolwork, to communicate with others, and for entertainment. These results also suggest that interventions may be useful to change attitudes endorsing illicit uses of the Internet.

Abstract

This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.

Abstract

This study investigated the relationships of health beliefs and HIV/AIDS knowledge with frequency of condom use among women of childbearing age in four major Indian cities. Surveys were completed by 210 women attending six primary health care centers. Among the sexually active women (N = 139), 68% noted rare or no use of condoms during intercourse. Perceived benefits (p < .05) and normative efficacy in requesting condom use (p = .01) were related to a greater frequency of condom use. About 54% of women knew that breast milk could transmit HIV, but fewer than a third were aware that an HIV-positive mother does not always infect her infant at delivery. Most participants endorsed HIV testing for women prior to pregnancy. Approximately three fourths of participants advocated abortion for HIV-seropositive pregnant women. Intervention efforts may benefit from dispelling misconceptions about AIDS (particularly regarding vertical transmission), emphasizing perceived benefits and women's efficacy in requesting condom use, increasing the availability of HIV testing, and highlighting choices for seropositive women of reproductive age as alternatives to abortion.

Abstract

Runaway youth are 6-12 times more likely to become infected with HIV than other youth. Using a quasi-experimental design, the efficacy of an HIV prevention program was evaluated over 2 years among 2 groups of runaways: (1) those at 2 shelters who received Street Smart, an intensive HIV intervention program, and (2) youth at 2 control shelters. Street Smart provided youth with access to health care and condoms and delivered a 10-session skill-focused prevention program based on social learning theory to youth. Prior to analysis of the intervention's outcomes, propensity scores were used to identify comparable subgroups of youth in the intervention (n = 101) and control conditions (n = 86). Compared to females in the control condition, females in the intervention condition significantly reduced their unprotected sexual acts at 2 years and alcohol use, marijuana use, and the number of drugs used over 12 months. Male adolescents in the intervention condition showed significant reductions in marijuana use over 6 months compared to control youth. Adolescent HIV prevention programs must proactively identify mechanisms for maintaining behavior change over the long-term, and innovative research designs are needed to allow examination of agency-level interventions.

Abstract

This study evaluated the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE, a standardized screening instrument for detecting alcohol dependence in identifying binge drinking among highly educated employees. Brochures were mailed to an entire workforce inviting employees to learn about their coping strategies, stress levels, and risk for alcohol-related problems, with 228 employees providing complete data. Binge drinking in the previous 3 months was reported by 29% of the employees, with greater binge drinking reported by White employees, of mixed/other ethnic background, or younger. The AUDIT achieved a sensitivity of 35% in identifying respondents who reported binge drinking and a specificity of 98% in accurately identifying respondents who did not report binge drinking. Sensitivity using the cut-off of scoring one or more positive hits on the CAGE was 67%, and specificity was 84%. Therefore, neither the AUDIT nor the CAGE achieved adequate sensitivity, as well as specificity, as screening tools for assessing binge drinking. A more accurate method for assessing binge drinking appears to be by directly asking for the largest number of drinks consumed in a single drinking session.

Abstract

This study examined the prevalence of sexually transmitted diseases (STDs) as well as the relationships between STDs and coping strategies used to deal with the stress of living with HIV among adults. The sample comprised 179 men and women, 58% were Caucasian, 54% were male, more than half (61%) were diagnosed with AIDS, 43% were heterosexual, and 39% reported an STD post-HIV diagnosis. Logistic regression analysis indicated that individuals reporting longer time elapsed since HIV diagnosis and greater use of emotion-focused coping were more likely to report STDs. There was an interaction effect between time and coping such that the less time that elapsed since HIV diagnosis and the more an individual used emotion-focused coping, the more likely they were to report an STD. Tailoring interventions to address specific stressors associated with length of time living with HIV, may be a particularly effective prevention strategy.

Abstract

This study was initiated by breast cancer survivors living in a rural community in California. They formed a partnership with academic researchers to develop and evaluate a low-cost, community-based Workbook-Journal (WBJ) for improving psychosocial functioning in geographically and economically isolated women with primary breast cancer.A randomized controlled trial was used to compare the WBJ intervention plus educational materials to educational materials alone (usual care).One rural cancer center and several private medical, surgical, and radiation oncology practices in 7 rural counties in the Sierra Nevada Foothills of California.One hundred women with primary breast cancer who were either within 3 months of diagnosis or within 3 months of completing treatment.A community-initiated, theoretically-based Workbook-Journal, designed by rural breast cancer survivors and providers as a support group alternative. It included compelling personal stories, local rural resources, coping strategies, and messages of hope.Community recruiters enrolled 83% of the women referred to the study. Retention at 3-month follow-up was 98%. There were no main effects for the WBJ. However, 3 significant interactions suggested that women who were treated in rural practices reported decreased fighting spirit and increased emotional venting and posttraumatic stress disorder symptoms if they did not receive the WBJ. Among women who receive the WBJ, 74% felt emotionally supported.This community-based Workbook-Journal may be an effective psychosocial intervention for rural, isolated, and low-income women with breast cancer. Community involvement was essential to the success of this project.

Abstract

This preliminary study explored relationships between women's empowerment and HIV prevention on the national and individual level with a focus on Botswana. Among sub-Saharan Africa countries, HIV prevalence was positively correlated with indirect indicators of women's empowerment relating to their education (female enrollment in secondary education and ratio of female to male secondary school enrollment), but not to their economic status (female share of paid employment in industry and services) or political status (women's share of seats in national parliament), while controlling for gross national income, percentage of births attended, and percentage of roads paved. Condom use at last sexual encounter was positively and significantly correlated with both indicators of women's educational empowerment, but was not significantly related to the other two indices. Empowerment at the individual level was explored through a preliminary quantitative survey of 71 sexually active women in Gaborone, Botswana, that was conducted in February 2001. Regression analyses showed that women's negotiating power and economic independence were the factors most strongly related to condom use, and did not show that education was a crucial factor. Economic independence was the factor most strongly related to negotiating power. These results suggest that in Botswana, HIV prevention efforts may need to improve women's negotiating skills and access to income-generating activities.

Abstract

This study examined the relationship of adherence to antiretroviral treatment with three types of social support (partner, friends, and family) and use of two coping strategies (denial and substance use). Participants were 73 men and women with HIV infection drawn from a larger sample of 186 clinical trial patients. Based on inclusion criteria, parent trial participants taking antiretroviral therapies, and those with complete data on self-reported measures of adherence were considered eligible for the present study. Overall, 26% of participants were found to be nonadherent, which was defined as one or more missed doses of treatment in the prior 4-day period. Logistic regression analysis was conducted to determine associations of sociodemographic and psychosocial variables with adherence to antiretroviral regimen. Results indicated that heterosexual participants (p < 0.01) and participants of Latino ethnicity (p < 0.05) were significantly more likely to report missed medications. Perceived satisfaction with support from a partner was associated with taking antiretroviral therapy as prescribed, whereas satisfaction with support from friends and from family was not significantly related to adherence. Examination of coping strategies showed that participants reporting drug and alcohol use (p

Abstract

This study examined the prevalence and factors associated with alternative therapy use in an ethnically diverse, gender-balanced sample of persons living with HIV/AIDS. More than two thirds (67%) of the participants who were taking HIV-related medications were also taking an alternative supplement. Half of the sample (50%) reported that they took one or more multivitamins, 17% reported using mineral supplements, 12% reported using Chinese herbs, and 12% reported using botanicals. Substantial proportions of the sample also reported using acupuncture (31%), massage (23%), and meditation (28%) to specifically treat HIV-related symptoms. Women were four times more likely to use alternative therapies than men. Also, Caucasians were nearly four times more likely to use alternative treatments compared to other ethnic groups. The results of this study indicate a strong need to assess individual patients' use of alternative treatment approaches as well as to further investigate their efficacy among HIV-positive patients.

Abstract

This study was designed to examine the course of psychological distress and pain from study entry to death in 59 women with metastatic breast cancer participating in a randomized trial of the effects of group psychotherapy on psychosocial outcomes and survival. It was hypothesized that psychological distress would increase significantly before death independent of changes in pain.Data were collected as part of a larger study (N = 125). Analyses were based on data from a subset of women who had died and for whom we had data from at least three assessments. Mean levels of mood, trauma symptoms, depression symptoms, well-being, and pain over three time points were examined: at baseline (T1), the second-to-last assessment before death (T2), and the last assessment before death (T3).Results indicate that while psychological distress remained relatively constant or declined from T1 to T2, means on all measures significantly changed in the hypothesized direction from T2 to T3. Neither self-reported pain, nor the passage of time, appeared to account for these changes. Additionally, participation in group psychotherapy did not have a significant impact on this change in distress proximal to death.Results suggest that specialized end-stage clinical interventions are particularly needed for cancer patients as they approach death. Moreover, intervention studies for patients with deteriorating illnesses may need to take this "spike" in psychological distress and pain proximal to death into account to avoid Type II errors in evaluations of psychological outcomes.

Abstract

This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.

Abstract

Women with breast carcinoma commonly experience psychologic distress following their diagnosis. Women who participate in breast cancer support groups have reported significant reduction in their psychologic distress and pain and improvement in the quality of their lives. Web-based breast cancer social support groups are widely used, but little is known of their effectiveness. Preliminary evidence suggests that women benefit from their participation in web-based support groups.Seventy-two women with primary breast carcinoma were assigned randomly to a 12-week, web-based, social support group (Bosom Buddies). The group was semistructured, moderated by a health care professional, and delivered in an asynchronous newsgroup format.The results indicate that a web-based support group can be useful in reducing depression and cancer-related trauma, as well as perceived stress, among women with primary breast carcinoma. The effect sizes ranged from 0.38 to 0.54. Participants perceived a variety of benefits and high satisfaction from their participation in the interventionThis study demonstrated that the web-based program, Bosom Buddies, was effective in reducing participants' scores on depression, perceived stress, and cancer-related trauma measures. The effect size of the intervention was in the moderate range. Although web-based social support groups offer many advantages, this delivery mechanism presents a number of ethical issues that need to be addressed.

Abstract

The relationships of drinking, stress, life satisfaction, coping style, and antidepressant use to mental health were examined in a highly educated workforce.This study used a one-time mail-out, mail-back cross-sectional survey design to examine the relationships of mental health with three kinds of stress (life events, work stress, home stress); two kinds of life satisfaction (work and home); use of avoidance coping; and antidepressant use.This study was conducted at a large worksite in northern California in which the workforce was comprised of predominantly highly educated employees.Questionnaires were mailed to a random sample of 10% of 8567 employees, and 504 were completed and returned by participants (59%). Complete data were provided by 460 participants (53%).Respondents completed the Mental Health Index, the Alcohol Use Disorders Identification Test (AUDIT), and measures of coping style, work and home stress and satisfaction, stressful life events, and antidepressant use.Mean Mental Health Index scores were at the 32nd percentile of the U.S. population-based norms, with low percentile values associated with worse mental health. Using multiple regression analysis, the factors examined in this study were significantly related to Mental Health Index scores as the dependent variable [F(16, 443) = 27.41, p < .001, adjusted overall R2 = .48]. Poor mental health scores were significantly related to the following: age (p < .05); screening positively for current harmful or hazardous drinking (p < .05); having high levels of stress at work (p < .05) or home (p < .01); experiencing dissatisfaction with work (p < .001) or home life (p = .01); engaging in avoidance coping (p < .001); and using antidepressants (p < .001). Employees currently using antidepressants had significantly more outpatient medical and mental health visits, indicating higher health costs. Furthermore, mental health status was also significantly related to the interactions between several pairs of these variables: education and gender, age and job stress, home satisfaction and work stress, home satisfaction and avoidance coping, and home satisfaction and use of antidepressants.Mental health status was poorer on average in a highly educated workforce compared with general U.S. norms. Most of the factors that were found to be associated with poorer mental health were ones that are potentially modifiable, such as experiencing more stress and less satisfaction in work and home life and engaging in current hazardous or harmful drinking. The findings that mental health is worse among individual employees who exhibit combinations of these factors suggest that we need to better understand possible effects of these factors in the context of one another. As interpretation of these results may be limited by the single worksite that participated in this study, future research should re-examine these relationships in other worksites varying from this one in geography and demographic characteristics.

Relationship of functional quality of life to strategies for coping with the stress of living with HIV/AIDSPSYCHOSOMATICSVosvick, M., Koopman, C., Gore-Felton, C., Thoresen, C., Krumboltz, J., Spiegel, D.2003; 44 (1): 51-58

Abstract

The authors examined factors associated with four dimensions of functional quality of life (physical functioning, energy/fatigue, social functioning, and role functioning) in 142 men and women living with HIV/AIDS. Participants completed the Brief COPE inventory and the Medical Outcomes Study Health Survey, with HIV-relevant items added. Greater use of maladaptive coping strategies was associated with lower levels of energy and social functioning. Pain severe enough to interfere with daily living tasks was associated with a lower level of functional quality of life on all four quality of life dimensions. Interventions aimed at developing adaptive coping strategies and improving pain management may improve functional aspects of quality of life in persons living with HIV/AIDS.

Abstract

The purpose of this study was to examine the relationships between social support, coping, mood and sexual risk behavior. Participants were 122 HIV-positive adults (60 women and 62 men). All participants were assessed on sexual risk behavior, perceived partner social support, coping with HIV/AIDS and mood. The results showed that sexual risk behavior was associated with male gender, education, perceived support of their partners and the use of emotion-focused coping style to deal with living with HIV and AIDS. Intervening with partners and developing effective coping strategies may decrease risk among HIV-positive men and women. Indeed, effective HIV prevention interventions must consider the social, psychological and cultural context in which sexual risk behavior occurs and develop strategies that intervene on these psychosocial factors.

Abstract

We examined sleeping problems in women with metastatic breast cancer in relation to depression, social support, and salivary cortisol. Ninety-seven women with metastatic breast cancer were drawn from a larger study on the effects of group therapy on quality of life and survival. This study is based on the baseline assessments conducted prior to randomization into treatment conditions. Sleep, depression symptoms, and social support were assessed by self-reporting. Cortisol was assessed from saliva samples taken over a 3-day period. Medical status and demographic characteristics were also examined in relation to each sleep variable in multiple regression analysis. Most women (63%) reported one or more types of sleep disturbance and 37% reported using sleeping pills in the previous 30 days. Problems with falling to sleep were significantly related to greater pain and depressive symptoms. Problems of waking during the night were significantly associated with greater depression and less education. Problems in waking/getting up were significantly associated with greater depressive symptoms and less social support. Sleepiness during the day was not significantly related to the variables in the regression model. Fewer hours of sleep were significantly associated with metastases to the bone, higher depressive symptoms, and more social support. Women who reported sleeping 9 or more hours per night, compared to those who reported a moderate amount of sleep (6.5-8.5 hours), had significantly lower 9 p.m. cortisol levels. Use of sleeping pills was more frequent among women reporting greater pain and depressive symptoms. These results suggest that women with metastatic breast cancer who are at higher risk for having sleeping problems are those who are less educated, in pain, depressed, have bony metastases, or lack social support.

Abstract

Considerable evidence suggests that exposure to traumatic events increases the risk of developing anxiety-spectrum disorders in response to later traumatization. We conducted a survey in Guadalajara, Mexico to assess factors associated with acute stress reactions to the assassination of a political figure. Participants included 86 adults who completed the Stanford Acute Stress Reaction Questionnaire (SASRQ) and measures of the perceived impact of the assassination, exhibited emotional behavior following the assassination, and had exposure to a specific prior disaster (a gas pipeline explosion). The results suggest that acute stress reactions can occur in response to an assassination, and that those most susceptible are those most emotionally invested, those who engage in emotional behavioral responses, and those whose lives have been affected by a previous potentially traumatic event.

Abstract

This study examined the effects of a Supportive-Expressive group therapy intervention offered to lesbians with early stage breast cancer. Twenty lesbians diagnosed with breast cancer in the previous 12-months were recruited and assessed at baseline, and at 3, 6, and 12 months after the group intervention. During the 12-week intervention, group members focused on the problems of a new diagnosis, coping with the illness and treatment, mood changes, coping responses and self-efficacy, improving relationships with family, friends and physicians, the impact of the illness on life, pain and sleep, and changes in body image and sexuality. A within-subject slopes analysis was conducted on data collected for each woman over the first year. As predicted, women reported reduced emotional distress, intrusiveness, and avoidance, and improved coping. There were significant changes in their social support, but in the unexpected direction. Instrumental support and informational support declined. However, conflict in family relations also declined, while trends were found towards more cohesiveness and expressiveness. Participants reported less pain and better sleep. There were no changes in body image, sexuality, or attitudes toward health-care providers. These results suggest that Supportive/Expressive group intervention appears to be helpful for lesbians with breast cancer.

Abstract

This study examined the concurrent and longitudinal relationships between traumatic stress symptoms and demographic, medical, and psychosocial variables among women recently diagnosed with primary breast cancer. Participants were 117 women drawn from a parent study for women recently diagnosed with primary breast cancer. At baseline, the Impact of Event Scale (IES) total score was related to intensity of postsurgical treatment and lower emotional self-efficacy. At the 6-month follow-up, the IES total score was significantly related to younger age, to the increased impact of the illness on life, and to the baseline IES total score assessment. These results suggest that it is important to intervene for traumatic stress symptoms soon after the diagnosis of breast cancer. Furthermore, these results suggest women at greatest risk are those who are younger, who receive postsurgical cancer treatment, who are low in emotional self-efficacy and whose lives are most affected by having cancer.

Abstract

The purpose of this study was to examine psychosocial correlates of adjustment to HIV/AIDS in a sample of 137 HIV-positive persons (78 men and 59 women). Multiple regression analysis was used to examine relationships between perceived quality of general social support, three attachment styles, and three coping styles with total score on Positive States of Mind Scale (PSOMS), our measure of adjustment. The influence of demographic and medical status variables was also accounted for. PSOMS total score was significantly associated with greater satisfaction with social support related to HIV/AIDS, more secure attachment style, and less use of behavioral disengagement in coping with HIV/AIDS. These results indicate that for people with HIV or AIDS, those individuals who are more satisfied with their relationships, securely engaged with others, and more directly engaged with their illness are more likely to experience positive adjustment. Implications for physical health outcome and opportunities for intervention are discussed.

Abstract

Four relatively independent emotion-regulation constructs (suppression of negative affect, restraint, repression, and emotional self-efficacy) were tested as outcomes in a randomized trial of supportive-expressive group therapy for women with metastatic breast cancer. Results indicate that report of suppression of negative affect decreased and restraint of aggressive, inconsiderate, impulsive, and irresponsible behavior increased in the treatment group as compared with controls over 1 year in the group. Groups did not differ over time on repression or emotional self-efficacy. This study provides evidence that emotion-focused therapy can help women with advanced breast cancer to become more expressive without becoming more hostile. Even though these aspects of emotion-regulation appear trait-like within the control group, significant change was observed with treatment.

Abstract

This study examined posttraumatic stress disorder (PTSD) in human immunodeficiency virus (HIV)-positive women seeking medical care. Specifically, we examined traumatic life events, psychiatric treatment, social support, and demographic characteristics in relation to level of PTSD symptoms. We recruited and obtained informed consent from 47 ethnically diverse HIV-positive women from two HIV outpatient clinics in a county medical system. Forty-one of these women provided complete data on measures assessing demographics, traumatic life events, PTSD symptoms, social support, and psychotherapy/medical history. Analysis of the data demonstrated that a high percentage (42%) of the HIV-positive women were likely to meet criteria for full current PTSD, and an additional 22% for partial PTSD. Of the women likely with full PTSD, 59% were not receiving any psychiatric treatment, and of those likely with partial PTSD, 78% were not receiving any psychiatric treatment. Also, women reported having experienced a mean of 12 traumatic life events. As hypothesized, the level of PTSD was significantly related to the number of life events experienced (rs = 0.52, p < 0.001), and to perceived social support from friends (rs = - 0.34, p < 0.02) and family (rs = - 0.29, p < 0.05). Given the high percentages of women who were found to have experienced traumatic life events and high levels of PTSD symptoms, it seems important to assess and treat PTSD in women with HIV/acquired immune deficiency syndrome (AIDS).

Abstract

Obtaining a high response rate in survey research can bolster statistical power, reduce sampling error, and enhance the generalizability of the results to the population surveyed. We describe a mail survey designed to achieve a high return rate of completed questionnaires from members of the American Psychological Association who were engaged in clinical practice. We adapted the Total Design Method for survey research and were able to achieve a high response rate (68%) among health professionals. This was not an experiment in which we assessed the best method to increase survey response rates, hence we cannot empirically evaluate how each of the steps influenced our overall response rate. Future research is needed to identify the relative effectiveness of each of these principles in enhancing survey response rates. Research is also needed to distinguish general principles that apply across populations from those that must be tailored to specific subpopulations.

Abstract

To examine gender differences in heart rate and reports of negative and positive affect among adolescents during a speech task.Subjects were 133 adolescents, 73 girls and 60 boys, ages 14-18 years. Subjects were randomly assigned to speak for 10 minutes and asked either to free associate or to describe the most stressful event in their lives. Their heart rate was assessed at baseline and at 5 and 10 minutes after the task began. Self-ratings of negative and positive affect were assessed at baseline and at 10 minutes after the beginning of the task. Data were analyzed by Student's t-tests for independent samples, analyses of covariance, and Spearman rank-order correlation coefficients.Girls rated their negative affect significantly higher at baseline in comparison to boys. In addition, girls had a higher baseline heart rate. However, boys' increase in heart rate 5 minutes into the speech task was significantly greater than that of girls. Also, the free association task elicited significantly greater increases in heart rate compared to a task in which the adolescent described his or her most stressful life event. However, the stressful event task elicited greater negative and less positive affect. Significant relationships between change in heart rate and ratings of post-task affect were found among girls but not among boys, suggesting that the girls' ratings of their affect are more congruent with their physiological reactions to a stressful speech task.These results suggest that gender and task differences must be considered in assessing adolescents' stress.

Abstract

This study examined alcohol and licit and illicit drug use in a highly educated workforce. A comprehensive health survey of a 10% random sample of a workforce (n = 8,567) yielded a 60% response rate (n = 504) after accounting for 15 undeliverable surveys. Many respondents reported past-year use of alcohol (87%). Thirteen percent of respondents consumed three or more drinks daily; 15% were binge drinkers. Twelve percent of the workforce was assessed as having a high likelihood of lifetime alcohol dependence; 5% of respondents met criteria for current problem drinking. Overall, 42% reported using mood-altering prescription drugs (analgesics, antidepressants, sedatives, or tranquilizers). Eleven percent reported using illicit drugs (cocaine, hallucinogens, heroin, or marijuana) in the past year. Significant relationships were found between gender, age, ethnicity, and occupation with some measures of alcohol consumption and use of mood-altering drugs. These results indicate prevention and early intervention programs need to address use of mood-altering substances (including alcohol) in highly educated workforces.

Abstract

This study examined the prevalence of acute stress reactions to recent life events among persons living with HIV/AIDS. A second aim was to investigate the relationship of acute stress reactions among HIV-infected men and women to posttraumatic stress disorder (PTSD) symptoms to previous traumatic life events.Participants included 64 HIV-seropositive persons (33 men and 31 women) drawn from a larger study examining the effects of group therapy on quality of life and health behavior. These individuals were assessed at baseline on demographic and medical status characteristics and (PTSD) symptoms andthen randomly assigned to either receive group therapy plus education or education alone. Three months later they were assessed for acute stress reactions to recent life events.Nearly a third (31.3 percent) of the participants reported levels of acute stress reactions to recent life events that met all symptom criteria for the diagnosis of acute stress disorder. However, only 9.4 percent of the respondents described a recent stressful life event that was threatening to the life or physical integrity of themselves or others. Acute stress reactions to recent life events were significantly and positively related to experiencing PTSD symptoms to prior traumatic life events. Acute stress did not differ significantly by gender, AIDS status, or whether or not participants had received 12 weeks of group therapy.A subset of individuals with HIV/AIDS experience high levels of acute stress reactivity to life events considered non-traumatic. HIV-infected individuals who react strongly to ongoing life stressors are more likely to have developed PTSD symptoms in response to previous traumatic life events.

Abstract

Workforce productivity has become a critical factor in the strength and sustainability of a company's overall business performance. Absenteeism affects productivity; however, even when employees are physically present at their jobs, they may experience decreased productivity and below-normal work quality--a concept known as decreased presenteeism. This article describes the creation and testing of a presenteeism scale evaluating the impact of health problems on individual performance and productivity. A total of 175 county health employees completed the 34-item Stanford Presenteeism Scale (SPS-34). Using these results, we identified six key items to describe presenteeism, resulting in the SPS-6. The SPS-6 has excellent psychometric characteristics, supporting the feasibility of its use in measuring health and productivity. Further validation of the SPS-6 on actual presenteeism (work loss data) or health status (health risk assessment or utilization data) is needed.

Abstract

This study examined specific cultural beliefs and knowledge about HIV as well as tested components of the Health Belief Model in relation to condom use in Kisumu, Kenya. Interviews were conducted with 223 participants at six governmental and private clinics. Although 75% had engaged in intercourse during the preceding month, fewer than 20% had used a condom. For both men and women, perceived barriers was the only component of the Health Belief Model significantly associated with condom use, with greater perceived barriers being associated with lower frequency of condom use (p < .05). Additionally, individuals with more education and HIV/AIDS knowledge were less likely to endorse stigmatizing beliefs toward HIV/AIDS (p < .001), whereas people who believe that HIV originated in the United States were more likely to endorse these stigmatizing beliefs (p

Abstract

Adherence is a major problem facing HIV-seropositive patients. Low adherence has been associated with faster disease progression as well as development of drug-resistant strains of HIV. Thus it is critical to understand factors associated with treatment compliance. This study examined the independent contributions of disease severity, age, gender, household income, homelessness, ethnicity, and sexual orientation on appointment adherence.Participants (n = 671) scheduled for appointments in an outpatient county treatment facility for HIV-related medical care completed demographic questionnaires and clinic staff collected appointment attendance data.Multiple regression analyses indicated that patients diagnosed with AIDS, older in age, and receiving a higher income were more likely to keep medical appointments. Additionally, African American ethnicity and identifying as heterosexual were associated with missing scheduled medical appointments.These data suggest that cultural and sociodemographic characteristics influence patients' adherence to outpatient services. Implications for interventions aimed at increasing medical adherence are discussed.

Abstract

This study examined the effect of sexual revictimization on information processing of trauma-related stimuli in a sample of child sexual abuse (CSA) survivors diagnosed with posttraumatic stress disorder (PTSD). Fifty-one treatment-seeking women participated in this study. Participants completed the Sexual Experiences Survey regarding sexual revictimization in the last 6 months and performed a modified emotional Stroop task in which they named the colors of neutral words (e.g., apple), general threat words (e.g., malignant and death), and sexual/victimization words (e.g., penis and abuser). As predicted, the revictimized participants (n = 16) took significantly longer to color-name sexual/victimization words than did the nonrevictimized participants. These results suggest that revictimization serves to prime preexisting "trauma" memory networks, thereby amplifying the impact of childhood sexual trauma on selective attention toward trauma-related stimuli.

Abstract

Metastatic breast cancer carries with it considerable psychosocial morbidity. Studies have shown that some patients with metastatic breast cancer experience clinically significant anxiety and depression and traumatic stress symptoms. Supportive-expressive group psychotherapy was developed to help patients with cancer face and adjust to their existential concerns, express and manage disease-related emotions, increase social support, enhance relationships with family and physicians, and improve symptom control.Of 125 women with metastatic breast cancer recruited into the study, 64 were randomized to the intervention and 61 to the control condition. Intervention women were offered 1 year of weekly supportive-expressive group therapy and educational materials. Control women received educational materials only. Participants were assessed at baseline and every 4 months during the first year. Data at baseline and from at least 1 assessment were collected from 102 participants during this 12-month period, and these participants compose the study population.Primary analyses based on all available data indicated that participants in the treatment condition showed a significantly greater decline in traumatic stress symptoms on the Impact of Event Scale (effect size, 0.25) compared with the control condition, but there was no difference in Profile of Mood States total mood disturbance. However, when the final assessment occurring within a year of death was removed, a secondary analysis showed a significantly greater decline in total mood disturbance (effect size, 0.25) and traumatic stress symptoms (effect size, 0.33) for the treatment condition compared with the control condition.Supportive-expressive therapy, with its emphasis on providing support and helping patients face and deal with their disease-related stress, can help reduce distress in patients with metastatic breast cancer.

The response evaluation measure (REM-71): A new instrument for the measurement of defenses in adults and adolescentsAMERICAN JOURNAL OF PSYCHIATRYSteiner, H., Araujo, K. B., Koopman, C.2001; 158 (3): 467-473

Abstract

There is widespread agreement that the concept of defense is useful, but large-scale studies with representative cohorts are lacking. Self-report measures capturing conscious derivatives of defense can facilitate such studies. The authors report the design and initial performance of a new self-report measure of specific defenses.A 71-item questionnaire based on a developmental model of defenses was created, pilot tested, and refined. The item pool was given to two independent clinical researchers for the classification of items (concordance=98.5%). The instrument was then administered to 1,875 nonclinical subjects drawn from two suburban high schools and from a public waiting area of a local airport (1,038 female subjects; mean age=21.0 years, SD=11.9, range=13-89), who were also assessed with a simple screening measure covering demographic variables and satisfaction with life.The internal consistency of the questionnaire items was good. Two factors emerged from a factor analysis of the items, paralleling Vaillant's theoretical model. Most defenses made unique, significant contributions to these factors. Defenses and factors related in the expected direction with scores on life satisfaction in various domains.The Response Evaluation Measure is a brief, coherent, and potentially useful screening instrument for the assessment of defenses in adults and adolescents.

Abstract

This study examined distress, coping, and group support among a sample of rural women who had been recently diagnosed with breast cancer. We recruited 100 women who had been diagnosed with primary breast cancer at one of two time points in their medical treatment: either within a window up to 3 months after their diagnosis of breast cancer, or within 6 months after completing medical treatment for breast cancer. Their mean age was 58.6 years (SD = 11.6), and 90% were of white/European American ethnicity. Women completed a battery of demographic and psychosocial measures prior to being randomized into a psychoeducational intervention study, and then again 3 months later at a follow-up assessment. The focus of this article is on the women's self-reported psychosocial status at baseline. Many of the women experienced considerable traumatic stress regarding their breast cancer. However, this distress was not reflected in a standard measure of mood disturbance that is frequently used in intervention research (the Profile of Mood States). The average woman considered her diagnosis of breast cancer to be among the four most stressful life events that she had ever experienced. Also, women on average reported a high level of helplessness/hopelessness in coping with their cancer. On average, women felt that they "often" (but not "very often") received instrumental assistance, emotional support, and informational support. Women varied considerably in which kind of social group provided them with the most support, with as many reporting that they found the greatest support in spiritual/church groups or within their family units as with breast or general cancer groups. These results suggest that among these rural women with breast cancer, distress with the diagnosis of breast cancer must be carefully assessed, as women who are highly distressed about their breast cancer may not report general mood disturbance. Furthermore, the kinds of groups that rural women with breast cancer experience as most supportive need to be identified so that psychosocial interventions can be matched to breast cancer patients' individual needs.

Abstract

This study examined the relationships of sexual, physical and emotional abuse to emotional (internalizing) and behavioral (externalizing) problems among incarcerated girls and boys. Participants were youth who were remanded to the correctional facilities within a statewide juvenile correctional system in a southern state in the United States of America. Each participant completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographic characteristics. Multiple regression analyses indicated that girls were more likely than boys to internalize their problems. The only abuse variable that was positively and significantly associated with emotional problems was emotional abuse. Greater behavioral problems were significantly related to youths being younger in age, white ethnicity, history of sexual abuse, and history of physical abuse. There were overall gender differences for internalizing problems, but not for externalizing problems among incarcerated adolescents. Furthermore, physical and sexual abuses were related to externalizing problems but not to internalizing problems. Thus, different types of abuse appear to have different effects on adolescent behavior. Implications for future research and practice are discussed.

Abstract

In a study comparing lesbian and heterosexual women's response to newly diagnosed breast cancer, we compared data from 29 lesbians with 246 heterosexual women with breast cancer. Our hypotheses were that lesbian breast cancer patients would report higher scores of mood disturbance; suffer fewer problems with body image and sexual activity; show more expressiveness and cohesiveness and less conflict with their partners; would find social support from their partners and friends; and would have a poorer perception of the medical care system than heterosexual women. Our predictions regarding sexual orientation differences were supported for results regarding body image, social support, and medical care. There were no differences in mood, sexual activity or relational issues. Not predicted were differences in coping, indicating areas of emotional strength and vulnerability among the lesbian sample.

Abstract

This study examined symptoms of Acute Stress Disorder (ASD), which is often thought of as a precursor to PTSD, among 54 women who already had PTSD for childhood sexual abuse for which they were seeking treatment. We examined the prevalence of ASD symptoms as well as their relationships to trauma symptoms measured by the Trauma Symptom Checklist-40. The ASD diagnosis requires the occurrence of a traumatic life event as well as meeting specific symptoms criteria. We found that fourty-four percent of participants met all symptom criteria for ASD, but only three of these 24 participants described a traumatic life event. Moreover, ASD symptoms were significantly related to trauma symptom scores. These findings suggest that a significant proportion of women with PTSD for childhood sexual abuse may be highly symptomatic for everyday stressful events that would not be experienced as traumatizing to others. Thus, these individuals need assistance in coping with everyday life stressors that do not involve a serious threat or injury in addition to needing help to alleviate their trauma symptoms.

Abstract

A reliable and valid measure is needed for assessing the psychological symptoms experienced in the aftermath of a traumatic event. Previous research suggests that trauma victims typically experience dissociative, anxiety and other symptoms, during or shortly after a traumatic event. Although some of these symptoms may protect the trauma victim from pain, they may also lead to acute stress, posttraumatic stress, or other disorders. The Stanford Acute Stress Reaction Questionnaire (SASRQ) was developed to evaluate anxiety and dissociation symptoms in the aftermath of traumatic events, following DSM-IV criteria for acute stress disorder. We present data from multiple datasets and analyses supporting the reliability and construct, convergent, discriminant, and predictive validity of the SASRQ.

Abstract

The purpose of this study was to examine the relationships of coping, attachment style and perceived social support to perceived stress within a sample of HIV-positive persons. Participants were 147 HIV-positive persons (80 men and 67 women). Multiple regression analysis was used to examine the relationships of the demographic variables, AIDS status, three coping styles, three attachment styles and perceived quality of general social support with total score on the Perceived Stress Scale (PSS). PSS score was significantly associated with less income, greater use of behavioural and emotional disengagement in coping with HIV/AIDS, and less secure and more anxious attachment styles. These results indicate that HIV-positive persons who experience the greatest stress in their daily lives are those with lower incomes, those who disengage behaviourally/emotionally in coping with their illness, and those who approach their interpersonal relationships in a less secure or more anxious style.

Abstract

This study examined mood disturbance among women with metastatic breast cancer in relationship to partnership status, relationship quality, and partner's coping and mood disturbance. These associations were examined within a total sample of 125 metastatic breast cancer patients and a subsample of 48 of these patients and their partners. Partnered and single women were indistinguishable in mood disturbance when household income was statistically controlled. Results also showed that patients were less distressed when they rated the relationship higher in Cohesion--Expression and in Conflict and when their partners reported lower mood disturbance. One possible implication of these results is that in relationships in which a woman has metastatic cancer, she may benefit from open engagement of difficulties and conflict. Furthermore, alleviating her distress may be better achieved by focus on the couple relationship rather than her individual coping.

Abstract

This study used a cross-sectional design to examine the relationships between social support, both quantity (number of people) and quality (appraisal, belonging, tangible, and self-esteem), and neuroendocrine function (mean and slope of diurnal salivary cortisol) among women with metastatic breast cancer.Participants (N = 103) were drawn from a study (N = 125) of the effects of group therapy on emotional adjustment and health in women with metastatic breast cancer. They completed the Interpersonal Support Evaluation List and the Yale Social Support Index and provided saliva samples for assessment of diurnal cortisol levels on each of 3 consecutive days. Diurnal mean levels were calculated using log-transformed cortisol concentrations, and the slope of diurnal cortisol variation was calculated by regression of log-transformed cortisol concentrations on sample collection time.Mean salivary cortisol was negatively related to the Interpersonal Support Evaluation List subscales of appraisal, belonging, and tangible social support. No association was found between quantitative support or the esteem subscale of the Interpersonal Support Evaluation List and mean salivary cortisol. Measures of qualitative and quantitative social support were not associated with the diurnal cortisol slope.Results show that greater quality of social support is associated with lower cortisol concentrations in women with metastatic breast cancer, which is indicative of healthier neuroendocrine functioning. These results may have clinical implications in the treatment of breast cancer.

Abstract

This study examined levels of intrusion and avoidance symptoms and their relationships to past life stress, current emotional support, disease-related variables, and age in 125 women with metastatic breast cancer. The results indicate that a sizable proportion of these women experienced clinically significant levels of intrusion and avoidance symptoms related to their cancer, particularly those with both more stressful past life events and higher current levels of aversive emotional support. Additionally, both types of symptoms were associated with shorter time since recurrence, and avoidance symptoms were associated with smaller emotional support networks. These results indicate that metastatic breast cancer is an emotionally traumatic event for a significant proportion of women, particularly those with past life stressors and unsupportive social environments.

Abstract

This study examined the influence of sexual abuse history, gender, theoretical orientation, and age on beliefs about the prevalence of childhood sexual abuse among clinical and counseling psychologists.A mail survey design was used in this study. Participants were randomly selected from the American Psychological Association membership database. There were 615 psychologists who completed self-report measures on beliefs about the prevalence of childhood sexual abuse and demographic characteristics.Overall, clinicians' scores on the prevalence of childhood sexual abuse were moderate. There were significant gender differences on beliefs, suggesting that women were more likely believe that childhood sexual abuse is a common occurrence compared to men. Multiple regression analysis indicated that clinician characteristics (history of sexual abuse, gender, and theoretical orientation) were significantly related to beliefs about the prevalence of childhood sexual abuse. However, these characteristics only accounted for a small amount of the overall variance predicting beliefs.These results suggest that clinicians do not hold extreme beliefs regarding the prevalence of childhood sexual abuse. Moreover, certain clinician characteristics are associated with their beliefs, which in turn, may impact their clinical judgment and treatment decisions. Furthermore, much of the variance was unaccounted for in the model indicating that psychologists' beliefs are complex and are not unduly influenced by their personal characteristics. Implications for clinical practice and future research are discussed.

Abstract

This study examines the relationships between the bonding style of an incarcerated adolescent with parents and his/her current feelings of self-esteem, hopelessness, and suicidal thoughts and attempts. It also investigates differences between bonding to mother and bonding to father. Some 296 incarcerated adolescents were interviewed using the Parental Bonding Instrument. Significant relationships were found between youths' self-esteem, hoplessness, and suicidal behavior and their bonding style. Youths whose parent(s) had a parental bonding style of affectionless control reported the greatest distress, and youths whose parent(s) had an optimal bonding style reported the least distress. Differences were found between bonding styles with the mother and with the father. Attachment theory may be useful in targeting incarcerated youths who have affectionless control bonding with parent(s) for special interventions since these youths are most at risk for psychosocial problems.

Psychological perspectives on political assassination. Translated into Spanish, Perspectivas psicolsgicas del asesinato polmtico.Political psychology of the new century: A window through citizenshipKoopman, C.1999: 289-299

Abstract

Using the DSM-IV diagnostic criteria for acute stress disorder, the authors examined whether the acute psychological effects of being a bystander to violence involving mass shootings in an office building predicted later posttraumatic stress symptoms.The participants in this study were 36 employees working in an office building where a gunman shot 14 persons (eight fatally). The acute stress symptoms were assessed within 8 days of the event, and posttraumatic stress symptoms of 32 employees were assessed 7 to 10 months later.According to the Stanford Acute Stress Reaction Questionnaire, 12 (33%) of the employees met criteria for the diagnosis of acute stress disorder. Acute stress symptoms were found to be an excellent predictor of the subjects' posttraumatic stress symptoms 7-10 months after the traumatic event.These results suggest not only that being a bystander to violence is highly stressful in the short run, but that acute stress reactions to such an event further predict later posttraumatic stress symptoms.

Abstract

The purpose of this study was to examine relationships between emotional adjustment to advanced breast cancer, pain, social support, and life stress. The cross-sectional sample was compromised of 102 women with metastatic and/or recurrent breast cancer who were recruited into a randomized psychosocial intervention study. All women completed baseline questionnaires assessing demographic and medical variables, social support, life stress, pain, and mood disturbance. Three types of social support were assessed: (1) number of persons in support system; (2) positive support; and (3) aversive support. On the Profile of Mood States (POMS) total score, we found significant interactions between life stress and social support; having more people in the patient's support system was associated with less mood disturbance, but only among patients who had undergone greater life stress. Also, aversive social contact was significantly related to total mood disturbance (POMS), and having more aversive social contact was particularly associated with total mood disturbance (POMS) among patients who had undergone greater life stress. Pain intensity was associated with greater total life stress, and was not significantly related to social support. These results are consistent with the 'buffering hypothesis' that social support may shield women with metastatic breast cancer from the effects of previous life stress on their emotional adjustment; however, aversive support may be an additional source of life stress associated with emotional distress. Also, pain is greater among women with greater life stress, regardless of social support.

Views of international security and change in 1992 among Russian and American national security elites.Peace and Conflict: Journal of Peace PsychologyKoopman, C., Shiraev, E., Jervis, R., Snyder, J.1998; 4 (1): 35-57

Abstract

The aim of this study was to determine whether psychological adjustment to advanced breast cancer was positively associated with expressing emotion and adopting a fighting spirit and negatively associated with denial and fatalism. Total mood disturbance on the Profile of Mood States was used as the measure of psychological adjustment. The Courtauld Emotional Control Scale measured emotional expression, and the Mental Adjustment to Cancer measured fighting spirit, denial, and fatalism. The sample included 101 women with a diagnosis of metastatic or recurrent breast cancer. Fighting spirit and emotional expressiveness were found to be associated with better adjustment. No association was found between mood disturbance and denial or fatalism. Because this was a cross-sectional study, no conclusions regarding a causal relationship between adjustment and emotional expressiveness or adjustment and fighting spirit were possible.

Abstract

This study examined relationships between dissociative symptoms experienced in the immediate aftermath of the Oakland/Berkeley firestorm and contact with the fire, life events, demographic variables, and actions taken after learning about the fire. One hundred eighty-seven participants completed self-report measures about their experiences during and immediately following the fire. Dissociative symptoms were significantly related to contact with the fire, sex, and stressful life events. Also, dissociative symptoms were significantly related to engaging in certain activities, such as trying to get closer to the fire and going into blocked-off areas and crossing police barricades. These results suggest that dissociative symptoms may merit special attention in intervention focusing on the immediate aftermath of disaster.

Abstract

The authors propose a diathesis-stress model to describe how pathological dissociation may arise from an interaction between innate hypnotizability and traumatic experience.To support the proposition that pathological dissociation may reflect autohypnotic process, the authors highlight clinical and research data indicating parallels between controlled hypnotic dissociative states and uncontrolled pathological dissociative symptoms and summarize evidence of hypnotizability in persons with psychiatric disorders that manifest these symptoms. The authors present this evidence by examining dissociative symptomatology in four psychological domains: perception, behavior and will, affect, and memory and identity. In addition, modern cognitive and neuropsychological models of dissociation are briefly reviewed.Several lines of evidence converge in support of the role of autohypnosis in pathological dissociation. There is considerable evidence that controlled formal hypnosis can produce a variety of dissociations of awareness and control that resemble many of the symptoms in uncontrolled pathological dissociative conditions; and it is possible to discern in dissociative pathology the features of absorption, dissociation, and suggestibility/automaticity that characterize formal hypnotic states. There is also accumulating evidence of high levels of hypnotic capacity in all groups with dissociative symptomatology that have been systematically assessed. In addition, the widespread and successful therapeutic use of hypnosis in the treatment of many dissociative symptoms and conditions (and the potential for hypnosis to induce dissociative symptomatology) also supports the assumption that hypnosis and pathological dissociation share an underlying process.High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress.

Abstract

Relationships between sexual abuse and sexual risk, substance use, emotional distress, and conduct problems were examined among 190 runaways. Those who had been abused were significantly more likely than nonabused peers to engage in unprotected sex, have more sexual partners, and use alcohol and drugs, but did not differ in emotional distress. Those abused after age 13 were more often engaged in sex work than nonabused peers. Males abused before age 13 had more sexual partners than those not abused, and runaway males were significantly more likely to have been sexually abused than has been reported in prior research.

Abstract

To determine the HIV-related risk behaviors and STDs in a population of incarcerated adolescents in order to strategically target education and prevention efforts.A single point-in-time prevalence study based on an analysis of intake medical records of 1,215 incarcerated youth were analyzed for HIV risk behaviors and STD history.Incarcerated adolescents report high rates of risk behaviors for HIV infection and STDs, with 75% reporting three or more sex partners, 25% never using condoms and 19% having a current diagnosis of at least one STD. Significantly more females than males reported a history of STDs and had higher rates of current diagnoses of chlamydia/non-gonococcal urethritis, trichomonas and gonorrhea.Ethnic/racial and gender differences were found in risk behaviors for STDs among a sample of incarcerated adolescents.

Abstract

This longitudinal study examined predictors of patterns of change in HIV sexual risk acts among homosexual and bisexual adolescent males.A consecutive series of 136 homosexual and bisexual males aged 14-19 years were recruited into the study. Subjects were predominantly Hispanic (51%) and African American (31%) and seeking services at a homosexual-identified community-based agency in New York City. All subjects participated in an intensive HIV intervention program. Patterns of change in HIV sexual risk acts were based on assessments at four points (intake and 3, 6, and 12 months later) and were used to classify youths as demonstrating one of five patterns of anal and oral sexual acts: protected (anal: 45%, oral: 25%), improved (32% and 28%, respectively), relapse (5% and 8%), variable (8% and 15%), and unprotected (10% and 24%). Components of the health belief, self-efficacy, peer influence, coping, and distress models were assessed as predictors of these patterns.Protected and improved patterns of sexual risk acts were associated with low levels of anxiety, depression, and substance use and high self-esteem.These data suggest that HIV interventions must address non-HIV-related issues confronting youths in difficult life circumstances, particularly emotional distress and the role of peer networks for homosexual and bisexual youths.

Abstract

During and immediately following a traumatic event, people may manifest a pattern of dissociative and anxiety symptoms and other reactions, referred to as Acute Stress Disorder. A review of the empirical literature on psychological reactions to trauma suggest that this pattern of symptoms has often been identified across different kinds of traumatic events. It is likely to constitute a psychological adaptation to a stressful event, limiting painful thoughts and feelings associated with the event and allowing the person to function at least minimally. Continuation of these symptoms, however, may impair the person's quality of life and disrupt social and other functioning. If symptoms last beyond a month following the traumatic event, Post Traumatic Stress Disorder (PTSD) may ensue, continuing for months or even years after the precipitating event. Hence, it is important to be able to identify this pattern of reactions that may be manifested in reaction to trauma, so that appropriate intervention can be provided. Although it was not officially recognized in the 3rd edition Diagnostic and Statistical Manual (DSM-III-R), Acute Stress Disorder is included as a separate diagnosis in the DSM-IV.

Abstract

Although the existence of a relationship between depression and pain in patients with cancer has been known for many years, the influence of one upon the other is still poorly understood. It has been thought that depressed individuals complain of pain more because of their psychiatric illness. Evidence from two studies indicate that pain may induce clinical depression.In the first study, the authors examined both current and lifetime psychiatric diagnoses among patients with cancer who had high and low pain symptoms to examine the strength of the relationship between depression and cancer pain. The sample consisted of 72 women and 24 men, with 39 women and 9 men in the high pain group, and 33 women and 15 men in the low pain group. In the second study, 35 patients with metastatic carcinoma of the breast were examined for pain intensity and frequency and mood disturbance.The prevalence of depressive disorders of all types was found to be significantly higher in the high pain than in the low pain group across measures, 33 versus 13% (chi-square [degrees of freedom = 1] = 5.90, P < 0.05). Furthermore, there was a significantly higher history of major depression in the low pain group than in the high pain group (chi-square [degrees of freedom = 1] = 3.86, P < 0.05). Also, in comparison with patients in the low pain group, patients in the high pain group were significantly more anxious and emotionally distressed. In the second study, pain intensity correlated significantly with fatigue, vigor, and total mood disturbance, and pain frequency correlated significantly with fatigue, vigor, and depression.This study confirms the high concomitant occurrence of pain and psychiatric morbidity and suggests that pain may play a causal role in producing depression.

Abstract

The first execution in California since 1976 took place recently in the San Quentin Prison gas chamber. Eighteen journalists were invited as media eyewitnesses. The authors postulated that witnessing this execution was psychologically traumatic and that dissociative and anxiety symptoms would be experienced by the journalists.To investigate the prevalence and specific nature of these symptoms, questionnaires were sent to all the journalists about a month after the execution. The questionnaire contained 17 items assessing dissociative symptoms from the authors' questionnaire of 35 highly intercorrelated acute stress items. Fifteen of 18 of the witnesses returned the questionnaire. Items were endorsed on a scale of 0 ("have not experienced") to 5 ("very often experienced") and analyzed as being dichotomously present or absent. The mean age of the respondents was 37.6 (SD = 8.6) and mean years as a journalist were 15.2 (SD = 9.0). Nine subjects were men and six were women.Journalists witnessing the execution endorsed an average of 5.0 dissociative items, ranging from "I saw, heard, or felt things that were not really there" (endorsed by no one) to "I felt estranged or detached from other people" (endorsed by 60%). This prevalence of reported dissociative symptoms is comparable to that seen among persons who endured the recent Oakland/Berkeley, Calif., firestorm.The experience of being an eyewitness to an execution was associated with the development of dissociative symptoms in several journalists.

Abstract

The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire.Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire.Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events.These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.

Abstract

Lifetime and current alcohol and drug use and sexual risk acts were examined among 154 male and 148 female runaways, aged 11-19, predominantly Black and Hispanic, residing at four residential shelters in the New York City area. Most runaways reported alcohol (71%) and drug use (46%), with about a quarter (27%) using either alcohol or drugs at least once a week during the past 3 months. Physical symptoms of substance abuse were reported by 47%; 17% reported addiction. Current substance use was higher among males and Hispanics, and increased with age. Substance use was significantly related to reporting more sexual partners and less frequent condom use. The results suggest that HIV/AIDS prevention programs must target the reduction of alcohol and drug use as well as sexual risk acts.

Abstract

The stress associated with experiencing or witnessing physical trauma can cause abrupt and marked alterations in mental state, including anxiety and transient dissociative symptoms. Intense manifestations of this pattern of response to trauma are described in a new diagnostic category proposed for DSM-IV: acute stress disorder. Severe dissociative symptoms may predict subsequent posttraumatic stress disorder. Persons who experience a series of traumatic events may be especially vulnerable to a variety of dissociative states, including amnesia, fugue, depersonalization, and multiple personality disorder. Treatment for these symptoms emphasizes strengthening supportive interpersonal relationships and developing insight that reduces psychological pain by integrating the trauma into a meaningful, less self-blaming perspective.

Abstract

From 1988 to 1991, 139 runaways aged 11-19 years in the New York City area (n = 70 males, 69 females) were recruited from four shelters. Each runaway participated in a semistructured interview assessing beliefs and behavioral intentions regarding human immunodeficiency virus (HIV) testing. When asked how they would respond to being seropositive for HIV, 29% of runaways reported that they would engage in self-destructive acts and/or harm others (e.g., suicide, unprotected sex), 80% anticipated extreme distress, 47% expected difficulty securing housing and food, and 61% believed that friends were likely to avoid them. When presented with specific alternatives, fewer runaways anticipated self-destructive acts. Drug use, rather than sexual behaviors, would lead runaways to get tested for HIV. These results suggest that health-care providers must anticipate emotional distress and potential self-destructive behavior following receipt of documentation of HIV positive serostatus among runaways. Furthermore, prior to testing, youths' access to food, shelter, medical care, and social support must be secured.

Abstract

Lifetime sexual behaviors were examined among two samples of predominantly minority, male adolescents in New York City aged 12 to 18 (M = 16.3), believed to be at high risk for HIV infection: 59 runaway males in two residential shelters and 60 males attending a community agency (HMI) for gay and bisexual youths. Interviews regarding psychosexual milestones indicated that 93% of these youths had engaged in oral, anal or vaginal intercourse and/or anilingus, with a median of 11.0 female partners among runaway males and a median of 7.0 male partners among HMI males. Both groups initiated sexual activity at a relatively early mean age of 12.6 years. Each group reported a unique developmental sequence of psychosexual milestones. Consistent condom use was reported by 13% of the youths. One quarter of the youths reported involvement in prostitution. These findings detail the need for AIDS prevention programs for these youths.

Abstract

Risk of human immunodeficiency virus (HIV) infection exacerbates the already difficult lives of 1.5 million homeless adolescents in the United States. Homeless youths engage in sexual and substance-abuse behaviors that place them at increased risk of contracting HIV, and they demonstrate other problem behaviors that reduce their coping responses. Model HIV prevention programs and interventions for HIV-positive youths, implemented for homeless adolescents, need to be disseminated on a national level. Social policies must recognize adolescents' rights to satisfaction of basic survival needs; comprehensively address the needs of dysfunctional, disenfranchised, and single-parent families; and provide continuity of care for adolescents to facilitate independent living. Special provisions must be made when designing programs for gay, sexually abused, and substance-abusing youths.

Abstract

Reductions in runaways' sexual risk behaviors were evaluated in response to an intensive program to prevent human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS).In a nonrandomized control trial, sexual risk behaviors among 78 runaways at one residential shelter who received up to 30 HIV/AIDS intervention sessions were compared with 67 runaways at a nonintervention shelter with sexual behaviors assessed at baseline and 3 and 6 months.Runaways were recruited from the only two publicly funded shelters in New York, NY.The runaways were aged 11 to 18 years, 64% female, and predominantly black or Hispanic.The intervention addressed general knowledge about HIV/AIDS, coping skills, access to health care and other resources, and individual barriers to safer sex.Consistent condom use, a high-risk pattern of sexual behavior, and sexual abstinence over a 3-month time frame were assessed.As the number of intervention sessions increased, runaways' reports of consistent condom use increased significantly (at 3 months, unique R2 = .06, P less than .05; at 6 months, unique R2 = .09, P less than .05), and their reports of engaging in a high-risk pattern of sexual behavior decreased significantly (at 3 months, unique R2 = .03, P = .06; at 6 months, unique R2 = .04, P less than .05). Abstinence did not change.The demonstrated effectiveness of the intensive HIV/AIDS program highlights the importance of enlarging the scope of most current HIV/AIDS prevention programs.

Abstract

This study assessed general knowledge of AIDS, beliefs about preventing AIDS, and sexual behavior among two groups of male adolescents at high risk of HIV/AIDS: 60 sexually delinquent males and 57 non-delinquent runaway males. Significantly fewer sexually delinquent than non-delinquent (runaway) males had experienced sexual intercourse with a consenting female partner (45 vs. 89 per cent). Sexually delinquent youths scored significantly lower than non-delinquent youths in general knowledge of AIDS (65 vs. 73 per cent) and were not able to discriminate safer behaviors from those which were less safe (42 vs. 71 per cent). Both groups reported moderate support for beliefs about preventing AIDS. These results suggest HIV/AIDS prevention programs that attempt to increase knowledge are needed by these youths, particularly for sexually delinquent youths.

Abstract

Seroprevalence studies and documented sex and drug use risk behaviors indicate the importance of primary prevention programs for HIV among adolescents. Females and minority adolescents are at particular risk. Prevention workers must decide which strategies to advocate: abstinence, monogamy, HIV testing, screening partners, or explicit instruction of safer acts. Youths must be helped to personalize knowledge of HIV, acquire coping skills, and gain access to health care resources. Programs based on cognitive-behavioral models have been initially successfully in reducing risk behaviors, however, there is a need for more community-wide and media interventions. Adolescents' developmental features require that special attention be paid to implementation issues, including parent and peer involvement in the design of prevention programs.

Abstract

Current sexual risk behavior, AIDS knowledge, and beliefs about AIDS prevention were examined among 59 black and Hispanic male adolescents attending a community center for gay and lesbian youth. Most (73%) were sexually active in the last 3 months, with a median of 2.0 partners and with only 21% reporting consistent condom use. These youths demonstrated moderately high AIDS knowledge (82%) and positive beliefs endorsing AIDS prevention (71%). When risk pattern was defined on the basis of partners, risk acts, and condom use, positive AIDS prevention beliefs were significantly and inversely associated with the high-risk pattern, but not with abstinence. These results suggest that youths who frequently engage in high-risk acts need intervention targeting changes in beliefs and behavior, as well as knowledge.

Abstract

This report describes patients' requests for help in two outpatient settings--one, a general medicine practice (GMP); the other, a medical walk-in unit (WIU). Interview data were collected in 1981 from 200 patients prior to their visits with the doctor. Patients were asked, "How do you hope the doctor (or clinic) can be of help to you today?" Their responses were written down verbatim. A coding system was devised that described the specificity, focus, and form of each request in order to provide the clinician with a classification for recognizing these request elements and responding to them. Specificity (precision) was identified from the response to "What do you hope the doctor will do for you?" The focus (objective) was described by four categories: problem, treatment, relationship, and administration; the form (intervention), by five categories: somatic, cognitive, affective, advice, and instrumental. Patterns of requests differed in the two settings. In the WIU, the pattern of requests had a problem focus with a form split between the cognitive (wanting an explanation) and the somatic (wanting a medical procedure); in the GMP, treatment was the focus, with a somatic form. The overall results indicate the varied requests of medical outpatients that express their perspectives about their illnesses. This classification of requests should be useful to physicians in eliciting and responding to their patients' requests.

Abstract

This report describes the development of measures of AIDS knowledge and beliefs about AIDS prevention for adolescents. Review of the literature, focus groups, pilot testing, and reviews by advisory councils assured that the process of developing the measures contributed to their validity. These measures were administered to three samples of adolescents at high risk for contracting AIDS: 43 runaway males, 43 runaway females, and 36 self-identified gay males. Both the knowledge and the beliefs instruments showed moderately high internal consistency and test-retest reliability and successfully avoided ceiling effects. Gay males demonstrated significantly greater knowledge of AIDS; however, there were few differences in beliefs among the groups. Knowledge of AIDS was significantly correlated with beliefs about AIDS prevention. The results suggest that these measures identify gaps in knowledge and beliefs among high-risk youth.

Abstract

Relationships of patients' ethnicity to their reported pain, emotional distress and requests were investigated. When patients aged over 60 years were compared. Italian-Americans were found to more frequently report pain than were Anglo-Americans; however, this difference was not replicated in the younger patients of Italian and Anglo backgrounds. In addition to patients' age, their sex also was found to mediate the relationship of ethnicity to the expression of pain. In particular, older female Italian-Americans were likely to report pain while, in contrast, older male Anglo-Americans were not. Age and sex may be important mediators of ethnic differences because older and female patients may carry on ethnic traditions more than do younger and male patients. Ethnicity was not found to be significantly related to emotional distress and requests.

PROCESS ANALYSIS OF 2 DIMENSIONS OF THE NEGOTIATED APPROACH IN RELATION TO SATISFACTION IN THE INITIAL INTERVIEWJOURNAL OF NERVOUS AND MENTAL DISEASEEISENTHAL, S., Koopman, C., Lazare, A.1983; 171 (1): 49-54

Abstract

This study examined relationships between patient and clinician satisfaction ratings and the use of a negotiated approach to the initial psychiatric interview. Two dimensions of the negotiated approach were distinguished--mutuality in making treatment decisions and mutuality in communicating explanatory information. Forty-four patients sampled from a larger pool of 158 patients in a walk-in clinic of a large, urban general hospital participated in the study. At the conclusion of clinical interviews, three kinds of satisfaction ratings were obtained--those of patients' satisfaction, clinicians' perceptions of patients' satisfaction, and clinicians' own satisfaction. Transcripts of patients' audiotaped interviews with these clinicians were independently rated on each of the 10 negotiated approach process measures, comprising five measures of each process dimension. Patient satisfaction was found to be associated with explanatory processes--being given clear and complete explanations concerning the recommended treatment plan, its rationale, and its link to the patient's complaints, and with decision-making processes-stating a request before the start of the disposition phase and having the clinician pursue consensus with the patient on the clinician's recommended treatment plan. None of the negotiation variables was significantly correlated with clinician satisfaction. Moreover, clinicians appeared to be inaccurate in their perception of the sources of patient satisfaction. The study's findings suggest that two sources of strain between the clinician and the patient that may adversely affect the outcomes of their initial interview are the divergence in their value systems concerning initial interview processes and the clinician's misreading of the patient's perspective.